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To compare enteropathic spondylitis (ES) with psoriatic spondylitis (PS) and ankylosing spondylitis (AS), in patients on biological disease-modifying anti-rheumatic drug (bDMARD) treatment.Patients who were enrolled in the HUR-BIO registry were included. ES patients were considered as the main study group; AS and PS patients were included as the control groups. ES was defined as patients with inflammatory bowel disease (IBD) having inflammatory back pain/spine symptoms plus radiological sacroiliitis.Sixty-four ES patients (46.9% female), 128 AS patients (39.1% female), and 92 PS patients (62% female) were analysed. Baseline erythrocyte sedimentation rate (ESR) was significantly higher in the ES group than in the AS group. Both the baseline ESR and C-reactive protein were also higher in the ES group compared with the PS group. Among the first bDMARD use, infliximab use was higher in the ES group than the other groups. There was a marginal significant difference between the SpA subgroups in the retention rates of the first bDMARDs (log-rank, p=0.059). Ulcerative colitis was a significant predictor for switching of bDMARDs in comparison to Crohn's disease. Regarding the treatment responses, no significant differences were relevant for the three groups in terms of 50% improvement of the initial Bath Ankylosing Spondylitis Disease Activity Index score, the Assessment of Spondyloarthritis International Society partial remission score, and 20% improvement of ASAS score.A large majority of enteropathic spondyloarthritis patients on bDMARD treatment had radiographic sacroiliitis. ES patients had distinctive features that distinguish them from AS and PS patients.

Objective: Intravenous immunoglobulin is an alternative therapeutic agent that can be used off-label in many autoimmune rheumatological diseases. The aim of this study is to evaluate the autoimmune rheumatological diseases characteristics in which intravenous immunoglobulin therapy is used and the efficacy and safety of this therapy. Methods and Methods: We performed a retrospective review of 133 patients with autoimmune rheumatological disease who received at least 1 course of intravenous immunoglobulin treatment at Hacettepe University Rheumatology Outpatient Clinic between January 2013 and December 2020. The autoimmune rheumatological disease demographic and clinical features, organ involvements, treatment phases (primary-secondary or infection), treatment responses and adverse effects were evaluated. Results: A total of 79% (n=105) patients were female and the mean±SD age was 45.5±16.9 years. The most common underlying rheumatic diseases were systemic lupus erythematosus (35%, n=47) and dermatomyositis/polymyositis (35%, n=47). Intravenous immunoglobulin therapy was most commonly used for resistant/relapsed myositis and haematological involvement. The median (IQR) intravenous immunoglobulin treatment course was 6.5 (13) and the duration of intravenous immunoglobulin treatment was 10.8 (24) months. Although it is used as second-line therapy in 77% of patients, complete clinical response was observed in 32% and partial response in 47%. There was a significant reduction in the median (IQR) steroid doses (methylprednisolone or equivalent dose) patients received from baseline after intravenous immunoglobulin treatment [30 (33) vs 8 (12), p

We aimed to investigate the effects of colchicine, an important anti-inflammatory agent, on cognitive functions in a geriatric population diagnosed with gout or osteoarthritis by comparing it to non-colchicine users.138 geriatric patients (67 colchicine users and 71 non-users) were enrolled. Within comprehensive geriatric assessment (CGA), cognitive status assessment via Mini-Mental State Examination test (MMSE), Quick Mild Cognitive Impairment Screening test (Qmci), clock drowning test (CDT), and digit span tests were performed.Median age was 68 (65-72), and there were 82 female (59.4%) patients. The scores of CDT, Backward Digit Span Test, MMSE-Total, MMSE-Attention, MMSE-Motor Function, Qmci-Total Score, Qmci-Clock drawing, and Qmci-Logical Memory were significantly higher in the colchicine user group (p .005), showing better cognitive function. Adjusted model analysis showed that colchicine usage is independently correlated with higher Qmci-Total Score and Qmci-Logical Memory Score (For Qmci total score β = 7.87 95%CI = 5.48-10.27, p = 0.0001, and for Qmci Logical memory score β = 3.52, 95%CI = 2.12-4.91, p = 0.0001).To the best of our knowledge, this is the first study revealing that colchicine usage is associated with better cognitive performance in older adults. Further investigations with a prospective, larger-sampled and randomized design are needed to show the causal relationship between colchicine and cognition.

The drug retention rate has been an important indicator for evaluating the treatment tolerance. Unfortunately, our knowledge of the secukinumab retention rate in radiographic axial spondyloarthritis (r-AxSpA) is limited. The objective of this study was to assess the retention rate of secukinumab and evaluate predictive factors of drug survival based on data from a real-life cohort. We retrospectively assessed 147 r-AxSpA patients between May 2018 and January 2020 from the HUR-BIO database. Secukinumab retention rates were analyzed using the Kaplan-Meier method and Cox proportional hazard model was used for predictors factors. The global retention rate of secukinumab was 55% at 12 months. r-AxSpA patients with obesity had a lower frequency of secukinumab discontinuation (29% vs. 50%, p = 0.013) in comparison r-AxSpA patients without obesity. In multivariate analysis, multiple TNFi usage had a higher risk of secukinumab discontinuation [HR 1.99 (1.09-3.62), p = 0.024]; on the other hand, obesity had a lower risk [HR 0.45 (0.27-0.90), p = 0.008]. Except for not using multiple TNFi, this real-life analysis showed for the first time that obesity is not an adverse risk factor for secukinumab drug retention in r-AxSpA. Secukinumab, which is an interleukin-17A inhibitor, could act via a different pathway than tumor necrosis factor inhibitors (TNFi). The identification of predictive factors such as obesity that may affect the individual drug selection may provide more appropriate biologic treatment strategies for r-AxSpA.

Amaç: Neonatal lupus eritematozus, anti-SS-A/Ro ve anti SS-B/La antikorlarının transplasental geçişiyle fetal dokulara bağlanması sonucu ortaya çıkan edinsel otoimmün bir hastalıktır. Kütanöz, kardiyak, hepatik, nörolojik, akciğer ve hematolojik bulgularla ortaya çıkabilir. Literatürdeki bilgi birikimi daha çok kütanöz ve kardiyak tutulumu ağırlıklıdır. Bu çalışmanın amacı, literatür taraması yaparak hepatik, nörolojik, akciğer ve hematolojik tutulumumların gözden geçirilmesidir. Gereç ve Yöntem: 1976 yılından Ağustos 2015 tarihini kapsayacak şekilde Pubmed Medline’da literatür taraması yapıldı. MeSH terimleri kullanılarak yayınlar belirlendi: (''konjenital kalp bloğu, neonatal lupus‘' (MeSH)), ‘'insanlar'', ''İngilizce'' ile kısıtlamaları yapılarak tarandı. Vakaların bilgilerinin hasta bazında raporlandığı makaleler son analize dahil edildi. Hematolojik, hepatik, nörolojik ve akciğer tutulumu olan NLE hastalarının demografik, klinik ve laboratuvar verileri kaydedildi. Bulgular: Toplam 755 NLE hastasının verileri kaydedildi. Bu hastaların 117 (%15,5)’sinde hematolojik, 78 (%10,3)’inde hepatik, 10 (%1,3)’unda akciğer (%1.3) ve 9 (%1,2)’unda nörolojik tutulum saptanmıştır. Sonuç: Neonatal lupus eritematozus’da hematolojik, hepatik, akciğer ve nörolojik tutulum, kardiyak ve cilt tutulumuna göre daha az görülmektedir. Buna ragmen, klinisyenler NLE yönetimi sürecinde görülebilen bu tutulumlar açısından uyanık olmalılardır.

This study aimed to compare Tuberculin Skin Test (TST) and QuantiFERON (R)-TB Gold In-Tube (QFT-GIT) test in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients scheduled for biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) in a Bacillus Calmette-Guerin-vaccinated population. Adult RA (n = 206) and SpA (n = 392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups. Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cutoff (p < 0.001). Only 8.9% and 15% of the patients with RA and SpA, respectively, tested positive by QFT-GIT. The two tests poorly agreed in both groups at a TST cutoff of 5 mm and increasing the TST cutoff only slightly increased the agreement. Among age, sex, education and smoking status, pre-biologic steroid and conventional DMARD use, disease group, and QFT-GIT positivity, which were associated with a 5 mm or higher TST, only disease group (SpA) and QFT-GIT positivity remained significant in multiple logistic regression. TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cutoff for both diseases could result in overestimating LTBI in SpA.

Background: Gastroinestinal involvement in Behcet’s disease impacts morbidity and mortality. The diagnosis of gastrointestinal disease requires comprehensive evaluation with endoscopic and radiologic examinations which is costly and impractical. A biomarker is essential for non-invasive detection. Fecal S100A12 is an established biomarker in gastrointestinal inflammatory diseases and its serum levels are known to increase in Behcet’s Disease. In this study, we aimed to tests fecal S100A12 levels in Behcet’s patients, its relation with gastrointestinal symptoms to its potential as a biomarker in gastrointestinal involvement. Methods: We prospectively enrolled 48 cases of Behcet’s disease patients fulfilling International Study Group criteria from a university hospital. We excluded patients with other autoimmune conditions, active or recent infection, using NSAIDs and antibiotics. Control group was selected from volunteers who had applied to the rheumatology outpatient clinic. Patients with BD were categorized into 5 groups according to organ involvement. Also we evaluated and recorded disease activity with the BDCAF 2006. Fecal S100A12, fecal calprotectin and acute phase reactants were also collected. Results: Fecal calprotectin levels were six-fold higher in BD than controls (p

The Turkish grid system is under big dynamic changes. Renewables are continuously increasing, distribution privatization was completed. There are many participants of electricity system of Turkey. To synchronise all these needs scientific rules and regulations to be obeyed. On the other hand, although many rules, there is no any statistical data about how system operates effectively. What are the industrial plants faced with? Industrial plants connected to the national distribution or transmission grid at medium voltage level are really exposed to various grid events that affect firstly production efficiency, equipment, system failure and unexpected malfunctioning. Without data, there is no way to analysis and make clear definition of grid events. Recorded data for a long time in the point of common coupling will be used to evaluate existing status and to estimate next ones. In this paper, comparative power quality comparison will be analysed for 12 industrial plants distributed localized at five different industrial grid points. It is aimed to the seven different regions of our country compared to the facilities connected to the national system and compare them with a point from abroad. With this study, Turkish power quality intensity is realized by site data for next care of private sectors, private electric companies and industrial plants, and to give numerical data to literature.

Background:Patients with spondyloarthritis (SpA) have 3 important extra-articular involvement; psoriasis, uveitis and inflammatory bowel disease (IBD). Psoriatic arthritis (PsA) patients may have IBD, as well, and clinical features of PsA + IBD patients do not assess comprehensively, yet.Objectives:The purpose of this study is to determine the frequency and clinical features of concomitant PSA and IBD in a PsA biological DMARD cohort.Methods:Hacettepe University Rheumatology Biologic (HUR-BIO) is a single center biologic registry since 2005 and include 469 psoriatic arthritis patients to date. Demographics, clinical features, co-morbidities, laboratory and disease activity parameters collected from the database. The diagnosis of IBD was accepted with colonoscopy findings and pathology.Results:Overall, 469 PsA patients (70% females) with the mean age 47.7±12.4 years and [median (IQR)] disease duration 7 (3-11) years included in the study. Overall, 10/469 (5 male) PsA patients (2.1%) had IBD (7 (70%) with ulcerative colitis and 3 (30%) Crohn’s disease). Mean age of the patients was 53.3±10.0 years and mean disease duration was 9.0 ± 6.1 years. Six of ten patients were diagnosed with IBD before PsA and 4 of them were diagnosed with PsA first. Patients were followed-up for 3.7±2.8 years and bDMARD switch were made in 4 patients mostly due to primary inefficacy. bDMARD was discontinued in 2 patients (one for Crohn disease with fistula and one for drug induced SLE). According to DAPSA score 44% of the patients had low disease activity and 56% of the patients had moderate disease activity at last visit (9 patients were available). Sacroiliitis (70%) and severe radiographic hip (20%) involvement were common in PsA patients with IBD. Disease characteristics and demographic data are given in table 1.Table 1.Disease characteristics and demographic data of PsA patients with IBDAge (years) /sexDisease duration (years)IBD typeSacroiliitisLast visit treatments61/M16Crohn’s disease(+)Azathioprine, GC50/M5Ulcerative colitis(+), hipAdalimumab, GC59/F3Ulcerative colitis(+)Certolizumab, methotrexate40/F10Ulcerative colitis-Adalimumab, methotrexate71/M19Ulcerative colitis-Infliximab62/M13Crohn’s disease(+), hipAzathioprine, GC, sulphasalazine50/F1Ulcerative colitis-Adalimumab, GC59/M12Crohn’s disease(+)Secukinumab, GC45/F9Ulcerative colitis(+)Adalimumab, methotrexate, GC36/F5Ulcerative colitis(+)Infliximab, methotrexate, GCConclusion:In our single center biological registry, relatively small portion of PsA patients had concomitant IBD, however, those cases may have severe axial involvement, particularly in hip involvement, and further studies needed for these subgroup. Physician should be aware those SpA subgroup, because treatment choices, particularly IL-17 inhibitors may have some cautions patients with PsA and IBD.Disclosure of Interests:Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Berkan Armagan: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Emine Duran: None declared, Levent Kiliç: None declared, Omer Karadag: None declared, Ali Akdoğan: None declared, Şule Apraş Bilgen: None declared, Ali İhsan Ertenli: None declared, Sedat Kiraz: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Background/aim Tumour necrosis factor inhibitors and anti-interleukin-6 (anti-IL-6) therapies are increasingly being used in Takayasu’s arteritis (TA) patients who are unresponsive to corticosteroids ± conventional immunosuppressive agents. The aim of this study is to assess the efficacy and safety of anti-IL-6 (tocilizumab) therapy in refractory TA patients in real life. Materials and methods Fifteen TA patients (86.7% were female) who received at least 3 cycles of tocilizumab therapy were retrospectively assessed by clinical, laboratory, and radiological evaluations before and after tocilizumab therapy. Results The median (min–max) age of the patients at evaluation was 35 (20–58) years and the median disease duration from diagnosis was 24 (12–168) months. The median (min.–max.) duration of follow-up after tocilizumab was 15 (3–42) months. There was a significant decrease in erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and patient global visual analogue scale (VAS) scores of patients after tocilizumab therapy. The median (min.–max.) ESR was 26 (5–119) vs. 3 (2–49) mm/h, P = 0.02; CRP was 39.8 (2.4–149.0) vs. 7.9 (0–92.9) mg/L, P = 0.017; and patient global VAS was 50 (0–90) vs. 30 (0–60), P = 0.027, respectively. In 8 patients, ESR and CRP levels were in the normal range in the last control. Imaging modality results after tocilizumab were available for 9 patients; 8 patients were radiologically stable and regression was seen in 1 patient. Comparable imaging modality results before and after tocilizumab were available for 5 patients; 4 patients were radiologically stable and regression was seen in 1 patient. Radiological findings were consistent with laboratory responses. Glucocorticoid dosages decreased from a mean dosage of 16.2 (9.1) mg/day at baseline to 7.1 (3.8) mg/day (P = 0.001) at the last follow-up visit. There was no increase in the steroid dosage in any of the patients. All patients tolerated tocilizumab well. Conclusion Based on retrospective real life data, anti-IL-6 (tocilizumab) appears to be an effective and tolerable treatment option in refractory TA patients.

To assess the real-life retention rate of certolizumab and factors related to retention of certolizumab.We analysed all patients who received at least 1 dose of certolizumab and were registered in the HURBIO database. Patients with at least 1 control visit were included in efficacy analysis. Drug retention rates were calculated using the Kaplan-Meier method and predictors of drug retention was determined by Cox proportional hazard model. Factors predicting BASDAI50 response at first visit were analysed by the logistic regression analysis. Reasons of switching and discontinuation were also determined.A total of 325 (AS (76%), female 55%) patients were recruited. Median follow-up while receiving certolizumab was 13 (4.7-22.7) months. At 1 year, overall certolizumab retention rate was 72.5%. Predictors of poor certolizumab retention were: Current or ex-smoker [HR 1.11 (0.70-1.76), p=0.65], high CRP levels [HR 0.72 (0.45-1.16), p=0.18], biologic-naïve [HR 0.81 (0.49-1.32), p=0.39] and good BASDAI50 response at first control visit [HR 0.54 (0.30-0.96), p=0.04]. Mean duration from starting certolizumab to the first control visit was 3 (3-6) months. Predictors of poor BASDAI50 response: Presence of nr-axSpa [RR 2.12 (1.01-4.51), p=0.05], female gender [RR 2.14 (1.20-3.82), p=0.01] and history of biologic therapy [RR 3.52 (1.95-6.33), p0.001]. The most common causes of drug switch were primary failure and drug side-effects.In this study, good BASDAI50 response at first visit seems to be a strong predictor of higher retention of certolizumab in patients with axial spondyloarthritis.

Background:Before using biological DMARDs, EULAR suggests the use of synthetic DMARDs (especially methotrexate) for RA and PsA [1-2].Objectives:It was aimed to evaluate the differences of disease duration and csDMARDs till first bDMARD in RA and PsA patients.Methods:HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 2070 RA and 520 PsA patients have been recorded. Demographic, clinical and laboratory data before bDMARDs of the patients were noted. When investigating the differences between groups, the effects of gender, age and disease duration wereadjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender, age and for indifference of the relevant groups by using prospensity score matching.Results:We incuded 481 RA, and 482 PsA age and gender matched patients in the study. Age, gender and disease duration information were given in the Table 1. 72.8% of the RA patients were RF or anti-CCP positive. Overall, 56.3, 100% of the RA, and PsA patients first biologic therapies were anti-TNFs, respectively. All RA patients started with csDMARDs before bDMARD treatments, whereas 450 of 482 (93.4%) PsA patients. Methotrexate was the anchor csDMARD for both diseases. RA patients more frequently used all csDMARDs included methotrexate, leflunomide, sulphasalazine hydroxychloroquine and corticosteroids as well. Median disease duration till bDMARD treatments in RA and PsA patients were 55 and 18.5 months respectively (pTable 1.emographic characteristics and csDMARDs before first bDMARDRA (n=481)PsA (n=482)P valueFemale, n (%)319 (66.3)332 (68.9)0.218Age, years (mean±SD)48.2 ± 13.547.4 ± 12.20.332Disease duration, years*10 (6-16)7 (3-12)0.000Symptom duration before diagnosis, years¥0 (0-1)1 (0-4)0.000*The period of time between diagnosis and bDMARD initiation, months¥55 (24-115)18.5 (8-58)0.000*The period of time between symptoms and bDMARD initiation, months¥70 (35-151)48 (20-124)0.000*MethotrexateEver n (%)400 (83.3)373 (77.5)0.015Just before bDMARD initiation n (%)251 (52.2)230 (47.7)0.093Hydroxychloroquine sulfateEver n (%)292 (60.8)170 (35.3)0.000*Just before bDMARD initiation n (%)262 (54.5)99 (20.5)0.000*LeflunomideEver n (%)237 (49.4)129 (26.8)0.000*Just before bDMARD initiation n (%)160 (33.3)96 (19.9)0.000*SulphasalazineEver n (%)353 (73.5)265 (55.1)0.000*Just before bDMARD initiation n (%)156 (32.4)146 (30.3)0.259*CorticosteroidsEver n (%)419 (87.3)281 (58.4)0.000*Just before bDMARD initiation n (%)335 (69.6)187 (38.8)0.000*¥Median (IQR)Conclusion:According to HUR-BIO real life data, for inflammatory arthritis patients who started bDMARDs, the periods of time between diagnosis and bDMARDs were more reasonable (18 months) in PsA patients than RA patient’s periods which were approximately three times longer. RA patients were used much more and longer duration of csDMARDs. This explicit distinction may be explained by synthetic DMARDs on activity differences between the RA and PsA.References:[1]Gossec, L., et al., EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 700-712.[2]Smolen, J.S., et al., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis, 2020. 79(6): p. 685-699.Disclosure of Interests:None declared

Background:In the last 20 years, anti-tumor necrosis factor (TNF) alpha agents re-designed the management of rheumatoid arthritis (RA). Despite this, unmet needs in the management of RA brought several drugs targeting different molecules and cytokines. It is still a research question that how did these developments changed daily-practice in RA patients who are intolerant/unresponsive to the first biological disease modifying anti-rheumatic drugs (bDMARD).Objectives:In this study, we aimed to explore the second biologic agent trends of our 20-years of single-center experience.Methods:HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.Results:A total of 776 (776/2080, 37.3%) RA patients, who was prescribed a second biological agent, was registered in HUR-BIO by the end of 2020. Of these patients, 83.7% was female. Mean age at the starting of bDMARD was 53.1 ± 13.3 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptid positivity was 69.1% and 60.5%, respectively. Distribution of first-line bDMARDs was as follows: adalimumab 194 (24.9%), etanercept 209 (26.9%), infliximab 105 (13.5%), golimumab 39 (5.0%), certolizumab 35 (4.5%), abatacept 78 (10.0%), rituximab 46 (5.9%), tofacitinib 37 (4.7%), tocilizumab 33 (4.2%). 11 (1.4%), 85 (11.0%), 282 (36.3%) and 398 (51.3%) patients were prescribed with their second bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time.Table 1.Distribution of second biologic DMARDs in RA patients according to 5-years periods2001-20052006-20102011-20152016-2020TotalAdalimumab3 (27.3)15 (17.6)69 (23.9)77 (18.9)164 (20.8)Etanercept8 (72.7)35 (41.2)49 (17.0)41 (10.1)133 (16.8)İnfliximab012 (14.1)13 (4.5)25 (6.2)50 (5.4)Golimumab0019 (6.6)8 (2.0)27 (3.4)Certolizumab002 (0.7)26 (6.4)28 (3.5)Anti-TNF11 (100)62 (72.9)152 (53.9)177 (44.5)402 (51.8)Tofacitinib004 (1.4)73 (17.9)77 (9.7)Tocilizumab0012 (4.2)81(19.9)93 (11.7)Rituximab022 (25.9)53 (18.3)32 (7.8)107 (13.5)Abatacept01 (1.2)61 (21.1)35 (8.6)97 (12.2)Non-Anti-TNF023 (27.1)130 (46.1)221 (55.5)374 (48.2)Total11 (100)85 (100)282 (100)398 (100)776 (100)Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015Conclusion:As the choice of second-line biologic and targeted synthetic DMARD, non-Anti-TNF bDMARDs, especially tofacitinib and tocilizumab becoming more frequent year-by-year. Despite that, anti-TNF agents as a group are still highly-prescribed options as second-line bDMARD.Disclosure of Interests:None declared

Background:Although focusing on the proliferative form of lupus nephritis (LN), recent reports also highlight the importance of recognizing and treating non-proliferative forms of LN.Objectives:In this study, we aimed to compare the clinical features and outcomes between proliferative and non-proliferative LN and to investigate the predictor factors of end stage renal disease (ESRD).Methods:This retrospective study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. 116 patients were diagnosed as LN. Biopsy findings had been classified according to the International Society of Nephrology and the Renal Pathology Society (ISN/RPS) classification. Demographics, disease involvements, laboratory values, treatment regimens, and outcomes in LN course were compared according to the proliferative and non-proliferative LN. Complete renal response within first 24 months was defined as ACR response criteria. Factors predicting the ESRD were analysed by the logistic regression analysis.Results:A total of 116 lupus nephritis patients were categorised class 3 (n=17, 14.7%) or 4 (n=77, 66.4%) as proliferative LN and class 2 (n=9, 7.8%) or 5 (n=13, 11.2%) as non-proliferative LN. Of these patients, 80.2% was female. Mean age at the SLE diagnosis and SLE manifestations were similar for both group. ANA (+) ≥ 1:320, ds-DNA level, APS antibodies, anti-Sm (+) were similar for proliferative and non-proliferative LN, but ds DNA positivity and low level of C3 and C4 were more frequent in proliferative LN. LN duration was similar. Median renal SLEDAI scores were higher in proliferative LN group. Induction treatment regimens included pulse steroid 72.3%, CyC 51.8%, MMF 24.6%, Rtx 6.1%, CsA 4.4%, and plasma exchange 12.9%. ESRD, renal transplantation and exitus were major complications of LN. Predictors of ESRD were duration of lupus nephritis (OR 1.32 [1.09-1.61]; 95% CI), decrease in GFR at the biopsy time (OR 0.97 [0.95-0.99]; 95% CI), and being in complete renal response within 24 months (OR 21.07 [2.28-194.36]; 95% CI).Conclusion:Unfortunately, LN patients still have worse outcomes, such as high ESRD rate, regarding to current effective immunosuppressive treatment regimens. Although patients’ number were not enough for conclusion, interestingly, worse outcomes were not related with proliferative or non-proliferative LN. Complete remission within 24 months was most relevant good prognostic factor, and clinicians should be kept in mind to these windows of opportunity period.Table 1.Demographic, clinical characteristics, and outcomes of the patients with lupus nephritisVariables*All patients (n=116)Class 3 or 4 LN (n=94)Class 2 or 5 LN (n=22)pAge at the SLE diagnosis, years22.5±13.123±13.320.3±140.32Sex, female93 (80.2)74 (78.7)19 (86.4)0.42SLE disease duration8 (8.7)8 (9.7)8.3 (7.5)0.66Lupus nephritis at diagnosis time67 (58.8)54 (58.7)13 (59.1)0.97Manifestation of SLE-Musculoscletal75 (66.4)63 (68.5)12 (57.1)0.32-Mucocutaneous60 (52.6)50 (54.3)10 (45.5)0.45-Hematologic47 (40.9)38 (40.4)9 (42.9)0.83-Serosal26 (23.2)21 (23.1)5 (23.8)0.94-Neurological6 (5.3)5 (5.4)1 (4.8)0.91Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.8 (0.5)0.6 (0.2)0.01-GFR (ml/min)110 (67)92 (55)145 (59)0.03-≥ 60 ml/min79 (79.8)63 (77.8)16 (88.9)-30-59 ml/min8 (8.1)7 (8.6)1 (5.6)0.55-< 30 ml/min12 (12.1)11 (13.6)1 (5.6)-24-hour urine protein≥ 1 gr/day72 (71.3)62 (76.5)10 (52.6)0.04≥ 3 gr/day36 (35.6)32 (39)4 (21.1)0.14-Active urinary sediment91 (83.5)78 (89.7)13 (59.1)0.001Renal SLEDAI at the biopsy12 (8)12 (8)8 (8)0.001Lupus nephritis duration (years)5.5 (8)5.1 (8.3)6.4 (4.8)0.73Complete renal response within 24 months69 (71.1)55 (72.4)14 (66.7)0.61End-stage renal disease13 (11.2)11 (11.7)2 (9.1)0.72Renal transplantation5 (4.3)4 (4.3)1 (4.5)0.95Exitus8 (7)7 (7.5)1 (4.5)0.62*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity indexDisclosure of Interests:None declared

Background:Renal biopsy is a cornerstone in the diagnosis and management of renal involvement in patients with systemic lupus erythematosus (SLE). However, non-lupus nephritis has been also observed in SLE patients with renal disease (1).Objectives:The aim of this study was to draw attention to the causes of non-lupus nephritis in SLE patients with kidney biopsy.Methods:This retrospective, descriptive study included 139 SLE patients who had at least one kidney biopsy between 2001 and 2020. All patients had fulfilled the SLICC or EULAR/ACR criteria for SLE. According to the pathology report results, 116 of the patients were diagnosed with lupus nephritis (LN), 18 patients had non-lupus nephritis, 2 biopsies were normal, and 3 biopsies were insufficient. Demographics, SLE disease duration, and renal biopsy diagnosis were derived from our hospital medical records.Results:Of the 23 patients (female:18/male:5), the mean age at the SLE diagnosis was 30.5 years and the median SLE disease duration was 8.5 (11.6) years. Pathologic report findings were compatible with focal segmental glomerulosclerosis in 6 patients, membranous nephropathy with no cellular proliferation and inflammation in 4 patients, thrombotic microangiopathy in 3 patients, IgM nephropathy in 2 patients, tubulointerstitial nephritis in 2 patients, and proliferative glomerulonephritis with monoclonal IgG deposits in one patient. There were no different for SLE manifestation in both gropus. LN vs other renal pathologies laboratory comparing as follow: ANA (+) ≥ 1:320 89 (76.7%) vs 14 (60.9%), APS antibodies 31 (33.7%) vs 8 (57.1), anti-Sm (+) 8 (11.8%) vs 1 (4.3%) were similar for LN and other renal pathologies, but anti-ds-DNA positivity 94 (84.7%) vs 10 (50%), median ds-DNA level 421 (591) vs 150 (340) and low level of C3 and C4 were more frequent in LN (pConclusion:Various renal lesions unrelated to lupus nephritis can be observed in SLE patients. Renal biopsy plays a critical role in identifying these lesions, which may have prognostic and therapeutic implications distinctive from those of lupus nephritis. Also, anti ds-DNA positivity/level, low C3 and C4, active urinary sediment and renal SLEDAI scores may give us some clues in terms of renal pathology for SLE patients. Moreover, almost half of the patients without LN in renal biopsy have anti ds-DNA positivity.References:[1]Howell DN. Renal biopsy in patients with systemic lupus erythematosus: Not just lupus glomerulonephritis! Ultrastruct Pathol. 2017 Mar-Apr;41(2):135-146.Table 1.Demographic, clinical characteristics and results of patients with and without lupus nephritisVariables*Lupus nephritis(N=116)Other pathologies(N=23)PAge at the SLE diagnosis, years22.5±13.130.5±14.50.006Sex, female93 (80.2)18 (78.3)0.83SLE disease duration8 (8.7)8.5 (11.6)0.27Manifestation of SLE-Musculoscletal75 (66.4)14 (63.6)0.8-Mucocutaneous60 (52.6)9 (40.9)0.31-Hematologic47 (40.9)10 (43.5)0.49-Serosal26 (23.2)4 (17.4)0.54-Neurological6 (5.3)1 (4.3)0.85Laboratory values for kidney biopsy-Creatinine level (mg/dL)0.7 (0.5)0.9 (0.6)0.17-GFR (ml/min)110 (67)77 (65)0.06-24-hour urine protein≥ 1 gr/day72 (71.3)17 (77.3)0.63≥ 3 gr/day36 (35.6)11 (50)0.23-Active urinary sediment91 (83.5)6 (27.3)Renal SLEDAI at the biopsy12 (8)4 (4)End-stage renal disease13 (11.2)2 (8.7)0.72Renal transplantation5 (4.3)1 (4.3)0.99Exitus8 (7)1 (4.3)0.99*n (%), if otherwise specified. Med (IQR) for numerical data excluding age; mean ± SD for age.GFR: Glomerular filtration rate, LN: Lupus nephritis, SLEDAI: Systemic lupus erythematosus disease activity indexDisclosure of Interests:None declared

Background:Idiopathic inflammatory myopathies (IIM) are heterogeneous groups of connective tissue diseases. Diagnosis of IIM is sometimes challenging, but newly defined myositis specific autoantibodies (MSAs) are helpful in diagnosing of IIM and revealing the clinical signs [1].Objectives:To describe demographic and clinical features of IIMs and to evaluate the frequency and clinical associations of myositis-specific and myositis associated antibodies (MAAs) in IIM.Methods:Samples obtained from patients tested for MSA/MAA as of 2017 to 2020 were retrospectively evaluated. Patients were diagnosed with IIM according to clinician diagnosis. The prevalence and clinical associations of myositis-related antibodies were assessed with univariate and multivariate analysis.Results:152 patients (70.4% female) were tested for myositis-related antibodies during the study period. 81 patients were diagnosed with IIM (38 DM, 43PM). DM patients were diagnosed at an earlier age and its association with malignancy was more relevant, although the relationship with malignancy was not statistically significant. Differences of clinical characteristics between DM and PM patients were skin features which were more frequent in DM, and interstitial lung disease which was more common in PM patients.MSAs/MAAS were found in 65.4% and 43.2% in IIM patients, more frequently than patients without IIM (p=0.000 and 0.0225, respectively). MSAs were equally frequent in both IIM groups, whereas MAAs were more common in the PM group (although no significant difference in overlap with other connective tissue diseases within these two diseases). The most common MSAs in DM were anti-TIF1-γ (23%), anti-MDA5 (16%), anti-NXP2 (13%) and in PM were anti-Jo-1 (28%), anti-MDA5 (12%), anti-ku (12%), anti-PL7 (12%) respectively. Predictors of ILD in IIM were Anti-Jo-1 positivity and age (RR:10 [CI:2-41] p=0.003 and RR:1.07 [CI:1.02-1.12] p=0.04 respectively)Conclusion:The general characteristics of DM and PM patients and the frequencies of myositis-specific autoantibodies were similar to the literature, except that anti-TIF1-γ antibodies (14%) were more common in our Turkish cohort [2].References:[1]Cruellas, M.G., et al., Myositis-specific and myositis-associated autoantibody profiles and their clinical associations in a large series of patients with polymyositis and dermatomyositis. Clinics (Sao Paulo), 2013. 68(7): p. 909-14.[2]Gonzalez-Bello, Y., et al., Myositis-Specific Antibodies and Myositis-Associated Antibodies in Patients With Idiopathic Inflammatory Myopathies From the PANLAR Myositis Study Group. J Clin Rheumatol, 2020.Table 1.Baseline characteristics of the patients with DM and PMDM (n=38)PM (n=43)PFemale, n (%)27 (71.1)29 (67.4)0.457Age at onset, years33 (15-48)47 (38-58)0.002Skeletal muscle features Muscle weakness, n (%)34 (89.5)37 (86.0)0.451 Myalgia, n (%)23 (60.5)30 (69.8)0.261 Artritis, n (%)8 (21.1)9 (20.9)0.601Skin features, n (%) Heliotrope rash, n (%)18 (47.4)0 (0) Gottron papules, n (%)25 (65.8)0 (0) Gottron sign, n (%)18 (47.4)0 (0) Generalize erythema, n (%)10 (26.3)0 (0)Calcinosis, n (%)4 (10.5)1 (2.3)0.143Dysphagia, n(%)10 (26.3)12 (27.9)0.537Interstitial lung disease (ILD), n (%)8 (21.1)20 (47.6)0.012Other connective tissue diseases overlap, n (%)6 (15.8)13 (30.2)0.102Malignancies, n (%)5 (13.5)3 (7)0.275Laboratory data Creatine kinase (IU/L)505 (110-3616)801 (402-1868)0.655 C-reactive protein (mg/dl)0.3 (0.1-0.8)1.2 (0.5-2.8) ESR (mm/h)19 (8-27)25 (17-48)0.005MAAs (Ro-52, pm-scl 100, pm-scl75), n (%)11 (28.9)24 (55.8)0.013MSAs, n (%)28 (73.7)25 (58.1)0.108 Anti- TIF1- γ, n (%)9 (23.7)2 (4.7)0.014 Anti-Jo-1, n (%)2 (5.3)12 (27.9)0.007 Anti-PL-7, n (%)05 (11.6)0.038Disclosure of Interests:None declared.

Background:Obesity has been suggested to be a chronic inflamatory condition and therefore, obesity may be considered as a risk factor for developing immune-mediated diseases, including inflammatory arthritis. In larger biologic registiries, obesity was found frequently in psoriatic arthritis than other inflammatory diseases such as rheumatoid arthritis and spondyloarthritis. [1-4]. However, obesity may be a reason of aging, moreover, there are strong sex differences between those diseases.Objectives:The aim of this study was to evaluate the obesity rates in sex and aged matched patients with inflammatory arthritis before the initation of biological therapy.Methods:HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005 and to date 5635 patients have been recorded. Demographic, clinical and laboratory data before bDMARD of SpA, RA and PsA patients were noted. The patients were divided into two groups: non-obese patients (2) and obese (≥30 kg/m2) patients. When investigeting the changes in BMI by diagnosis, the effects of gender and age were adjusted using two-way ANOVA and ANCOVA tests. The selection was made for the gender and age indifferences of the relevant groups by using propensity score.Results:5059 patients’ (1834 RA, 2741 SpA and 484 PsA) BMI data before the bDMARD treatments were avaliable and analysed. Baseline characteristics of RA, SpA and PsA patients were given in Table 1. 72.3% of the RA patients were seropositive. HLAB27 was positive in 64.7% and 22.9% of the SpA and PsA patients. Anti-TNF therapy was started as first bDMARD in 57.2% of the RA patients, others were started with non-Anti-TNF bDMARDs. In SpA (99.2%) and PsA (100%) patients anti-TNFs were the first biologics. Overall, the proportion of obese patients was significantly higher in RA and PsA than in SpA patients (Table 1) and age and sex affected BMI significantly (pTable 1.Baseline characteristics and BMI of the patientsRASpAPsApAll bDMARD patientsN18342741484Female, n (%)1470 (80.2)1257 (45.9)334 (69.0)0.000*Age, years*52.9±13.443.1±11.447.4±12.20.000*Disease duration, years¥11 (7-17)8 (5-13)7 (3-12)0.000*Body mass index*29.6 ± 6.527.7 ± 5.429.2 ± 5.80.000*Obesity, n (%)811 (44.2)815 (29.7)199 (41.1)0.000*Age and sex matched groupN481483484Female, n (%)315 (65.7)324 (67.1)334 (69.0)0.545Age, years*47 (36-59)48 (39-57)47 (38-56)0.691Disease duration, years¥10 (6-15)5 (5-13)7 (3-12)0.000*Body mass index*28.5 ± 6.128.5 ± 5.829.2 ± 5.80.150Obesity, n (%)183 (38.0)176 (36.4)199 (41.1)0.316* Mean ±S.D ¥Median (IQR)Conclusion:Although obesity was more frequently reported in RA and PsA patients, age and gender seemed to be the major factors in the occurrence of this difference rather than inflammatory arthritis subgroups. Therefore, when considering obesity as a factor in the registries, for instance biological registries, sex and age should be kept in mind.References:[1]Højgaard, P., et al., The influence of obesity on response to tumour necrosis factor-α inhibitors in psoriatic arthritis: results from the DANBIO and ICEBIO registries. Rheumatology (Oxford), 2016. 55(12): p. 2191-2199.[2]Liu, Y., et al., Impact of Obesity on Remission and Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken), 2017. 69(2): p. 157-165.[3]Moroni, L., N. Farina, and L. Dagna, Obesity and its role in the management of rheumatoid and psoriatic arthritis. Clin Rheumatol, 2020. 39(4): p. 1039-1047.[4]Zurita Prada, P.A., et al., Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol, 2020.Figure 1.BMI regarding to sex and diseases subtypesDisclosure of Interests:None declared

Background:In the last 20 years, there have been extraordinary improvements and practice-changing developments in the management of rheumatoid arthritis (RA). Exploring the pathogenetic mechanisms first enabled clinicians to use anti-tumor necrosis factor (TNF) alpha agents, then drugs targeting different molecules. Parallel to these developments, treatment guidelines have been changed accordingly. Meanwhile, how these developments have been reflected into the real-word practice is a question of interest.Objectives:In this study, we aimed to explore the first biologic agent trends of our 20-years of single-center experience.Methods:HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005. Patients who were started biologics before 2005 were registered retrospectively. In brief; demographic data, treatment-related data (including adverse events) and disease-related data of RA patients have been recorded in HUR-BIO. Until the end of the 2020, 21 different rheumatologists contributed to the development of HUR-BIO. In this study, distribution of the first-line biologic agents was calculated according to 5-year periods starting from the 2001. Also, demographic and serologic data of RA patients were reported.Results:A total of 2080 RA patients was registered in HUR-BIO by the end of 2020. Of these patients, 79.5% was female. Mean age at the starting of bDMARD was 53.3 ± 17.8 years. Rate of rheumatoid factor and anti-cyclic citrullinated peptide positivity was 67.6% and 61.0%, respectively. 65 (3.2%), 335 (16.1%), 858 (41.2%) and 822 (39.5%) patients were prescribed with their first bDMARD in 2001-2005, 2006-2010, 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs over time.Table 1.Distribution of first biologic DMARDs in RA patients according to 5-years periods2001-20052006-20102011-20152016-2020TotalAdalimumab15 (23.1)111 (33.0)187 (21.8)153 (18.6)466 (22.4)Etanercept30 (46.2)154 (45.8)229 (26.7)54 (6.6)467 (22.4)İnfliximab20 (30.8)58 (17.3)64 (7.5)7 (0.9)149 (7.1)Golimumab0037 (4.3)43 (5.2)80 (3.8)Certolizumab0037 (4.3)68 (8.3)105 (5.0)Anti-TNF65 (100)323 (96.4)554 (64.5)325 (39.5)1267 (60.9)Tofacitinib006 (0.7)212 (25.8)218 (10.5)Tocilizumab009 (1.0)102 (12.4)111 (5.3)Rituximab012 (3.6)136 (15.8)84 (10.2)232 (11.1)Abatacept00153 (17.8)99 (12.0)252 (12.1)Non-Anti-TNF012 (3.6)304 (35.5)497 (60.5)813 (39.1)Total65 (100)335 (100)858 (100)822 (100)2080 (100)Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, abatacept: 2010, tocilizumab: 2013, rituximab:2009, tofacitinib: 2015,Conclusion:Real-life practice in RA seems consistent with treatment guidelines. Use of non-Anti-TNF bDMARDs becoming more frequent year-by-year. Jak kinase inhibitor has rised through the last 5 years. Next decade may be the years of Jak kinases inhibitors.Disclosure of Interests:None declared

Background:Family history is one of the hallmarks of spondyloarthritis (SpA) and psoriatic arthritis (PsA) [1, 2]. Some patients have a strong family history that more than 2 relatives have spondyloarthritis related diseases. The effects of strong family history on SpA features were not known very well.Objectives:The aim of this study is to evaluate the effects of family history in SpA and PsA patients.Methods:HUR-BIO (Hacettepe University Biologic Registry) is a prospective, single center database of biological treatments since 2005, and to date 3071 SpA and 526 PsA patients have been recorded. Demographic, clinical characteristics, disease activity parameters, a detailed family history of SpA and SpA features (presence of SpA including PsA, psoriasis, inflammatory bowel disease and uveitis) and laboratory data before anti-TNF treatments of the patients were noted.Results:2807 SpA (53.6% male) and 506 PsA (31.4% male) patients’ family history were available and analysed. A positive family history was noted in 27.6% of the SpA and 31.0% of the PsA patients (ns). 7.4% of the SpA patients and 8.9% of the PsA patients had family history in more than one relative (Table 1). In SpA patients with a family history, uveitis was more frequent than patients without (14.4% vs 10.6%, p=0.006). Except for a higher male predominance and uveitis (53% vs 32% p=0.006 and 9% vs 2% p=0.003 respectively) in patients with ≥2 relatives with SpA features, there were no differences in PsA patients regarding family history. The presence of family history and HLA-B27 (63.7% vs 37.6%, pConclusion:Family history was present in about one third of the patients of PsA and SpA. It is not uncommon for two or more family members to have a SpA feature. Presence of family history may be associated with some clinical conditions, such as uveitis.References:[1]Solmaz, D., et al., Impact of Having Family History of Psoriasis or Psoriatic Arthritis on Psoriatic Disease. Arthritis Care Res (Hoboken), 2020. 72(1): p. 63-68.[2]Zurita Prada, P.A., et al., Influence of smoking and obesity on treatment response in patients with axial spondyloarthritis: a systematic literature review. Clin Rheumatol, 2020.Table 1.Family history in PsA and SpA patientsPsA (n=506)SpA (n=2807)≥ 1 family history, n (%)157 (31.0)774 (27.6)≥1 first-degree relative, n (%)114 (22.5)489 (17.4)≥2 first-degree relatives, n (%)21 (4.2)77 (2.7)≥2 relatives (both first- and second-degree), n (%)45 (8.9)208 (7.4)Family history •Psoriasis, n (%)120 (23.7)155 (5.5) •Psoriatic arthritis, n (%)14 (2.8)9 (0.3) •Spondyloarthritis, n (%)38 (7.5)643 (22.9) •Inflammatory bowel disease, n (%)1 (0.2)10 (0.4) •Uveitis, n (%)02 (0.1)Disclosure of Interests:None declared.

WOS: 000397050600018, PubMed ID: 27794533, Objective. The aim was to assess the characteristics of PsA, find out how well the disease is controlled in real life, demonstrate the treatments and identify the unmet needs. Methods. The PsA registry of Turkey is a multicentre Web-based registry established in 2014 and including 32 rheumatology centres. Detailed data regarding demographics for skin and joint disease, disease activity assessments and treatment choices were collected. Results. One thousand and eighty-one patients (64.7% women) with a mean (S.D.) PsA duration of 5.8 (6.7) years were enrolled. The most frequent type of PsA was polyarticular [437 (40.5%)], followed by oligoarticular [407 (37.7%)] and axial disease [372 (34.4%)]. The mean (S.D.) swollen and tender joint counts were 1.7 (3) and 3.6 (4.8), respectively. Of these patients, 38.6% were on conventional synthetic DMARD monotherapy, 7.1% were on anti-TNF monotherapy, and 22.5% were using anti-TNF plus conventional synthetic DMARD combinations. According to DAS28, 86 (12.4%) patients had high and 105 (15.2%) had moderate disease activity. Low disease activity was achieved in 317 (45.7%) patients, and 185 (26.7%) were in remission. Minimal disease activity data could be calculated in 247 patients, 105 of whom (42.5%) had minimal disease activity. The major differences among sexes were that women were older and had less frequent axial disease, more fatigue, higher HAQ scores and less remission. Conclusion. The PsA registry of Turkey had similarities with previously published registries, supporting its external validity. The finding that women had more fatigue and worse functioning as well as the high percentage of active disease state highlight the unmet need in treatment of PsA.

Background:Although psoriatic arthritis (PsA) may be seen at any decades, juvenil onset PsA is relatively rare. Moreover, there were no more data about clinical features, treatments, and course in juvenile PsA when they reached to adult age.Objectives:The objective of this study was to assess and compare demographic and clinical features for juvenile onset PsA and adult onset PsA.Methods:PsART-ID is a multicenter, international database, investigating the disease characteristic in real life (1). Briefly, demographic data, PsA subtypes, uveitis, enthesitis, dactylitis, Co-morbidities, disease activity scores (TJC, SJC, VAS-pain, VAS patients and physician global assessments, VAS-fatigue, BASDAI), and functional status (HAQ-DI, BASFI) were recorded. Psoriasis and PsA starting age were noted, as well. Patients were classified as juvenile PsA or juvenile PsO (under 18 years old). Results were compared regarding to juvenile versus adult onset age.Results:Overall, 1644 PsA patients were included to study, 301/1644 (18.3%) patients had juvenile onset psoriasis. Of 39/1644 (2.4%) patients had juvenile onset PsA, as well. As expected, juvenile onset PsA patients were younger, however PsA disease duration were longer than adult onset PsA patients. There were no any difference between demographic and clinical data, except BMI and enthesitis were less frequently at the juvenile onset PsA groups. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used more frequently bDMARDs.Table.Comparison of demographic and clinical characteristics of juvenile and adult-onset psoriatic arthritisJuvenile onsetAdult onsetpN (%)39 (2.4)1605 (97.6)Female Sex n (%)24 (61.5)1006 (62.7)0.884PsA beginning age mean (SD)13.3 ± 3.8542.3 ± 12.9Current age mean (SD)26.6 ±10.747.3 ±13.07Duration of psoriasis (years)17.10 ± 11.2614.75 ± 11.780.124Duration of psoriatic arthritis (years)13.5 ±115.06 ± 6.7Cigarette smoking (ever) n (%)15/38641/14940.72Education duration/year (mean,SD)10.09 ± 3.679.52 ± 4.810.464BMI (kg/m2) (mean, SD)24.5 ±5.128.3 ± 5.21Family history of PsO/PsA n (%)15 (38.5)559 (34.9)0.642Nail involvement n (%)18 (46.2)762 (47.5)0.864Dactilitis n (%)9 (23.7)367 (24)0.958Entesitis n (%)3 (7.9)384 (25.7)0.013Uveitis n (%)-13 (4.3)0.713Axial involvement (%)15 (38.5)464 (29)0.199Methotrexate36 (92.3)1348 (84)0.162Sulfasalazine17 (43.6)612 (38.1)0.488Leflunomide14 (35.9)379 (23.6)0.076Biologic DMARDs102 (33.9)358 (26.8)0.013Conclusion:Although psoriasis may be seen frequently in the juvenile age, juvenile onset PsA was not so frequent in our PsA cohort. Although, ever csDMARD using were similar between two groups, however, juvenile onset PsA patients were used bDMARDs more frequently.References:[1]Kalyoncu U et al. The Psoriatic Arthritis Registry of Turkey: results of a multicenter registry on 1081 patients. Rheumatology. 2017;56:279-286.Disclosure of Interests:Serpil ERGULU EŞMEN: None declared, Ozun Bayindir: None declared, esen kasapoğlu: None declared, Sibel Bakirci: None declared, Dilek Solmaz: None declared, Gezmiş Kimyon: None declared, Atalay Doğru: None declared, Ediz Dalkiliç: None declared, Cem Özişler: None declared, Meryem Can: None declared, Servet Akar: None declared, Emine Figen Tarhan: None declared, Sule Yavuz: None declared, Levent Kiliç: None declared, Orhan Küçükşahin: None declared, Ahmet Omma: None declared, Emel Gönüllü: None declared, Fatih Yildiz: None declared, Duygu Ersözlü: None declared, abdurrahman tufan: None declared, Muhammet Çinar: None declared, Abdulsamet Erden: None declared, Sema Yilmaz: None declared, Seval Pehlevan: None declared, Mehmet Tuncay Duruöz: None declared, Sibel Aydin: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB

Background Minimal disease activity (MDA) is an important target in patients with psoriatic arthritis (PsA), however it is also criticised for having low threshold for patient reported outcomes (PRO). Objectives The aim of the study was to assess the prevalence of MDA components in patients with PsA and to evaluate disease characteristics and patterns in patients with or without MDA. Methods PsArt-ID (Psoriatic Arthritis- International Database) is a prospective, multicentre web-based registry (www.trials-network.org). PsA patients who had at least 1 year of disease duration were included for this analysis. Patients were considered in MDA when they met at least 5/7 of the MDA criteria (figure 1). Results In January 2018, 1283 patients from Turkey and 119 patients from Canada were recruited, 317 of whom had full data for MDA and were included in this analysis. The demographics, disease characteristics and patterns in patients with MDA achieved vs not are summarised in the table. There were no differences regarding demographics in both groups. The monoarthritis subtype (RR: 2.01, 95% CI: 1.579–2.559), the absence of enthesitis (RR: 1.570, 95% CI: 1.027–2.398) and the absence of distal interphalangeal joint disease (RR: 1.1, 95% CI: 1.001–1.25) were associated with higher probability of achieving MDA. Across different domains included in MDA, pain VAS≤15 and PtGA ≤20 could less frequently be achieved even when MDA is fulfilled as 44.5% and 26.5% of patients respectively still did not fulfil these domains (figure 1). On the other hand, for patients that did not achieve MDA, the body surface area (51.2%) and swollen joint count (53.5%) domains could be achieved in the majority of the patients and 93.5% of them had no enthesitis using the Leeds enthesitis index. Physician global assessment (>21 vs≤20) and BASDAI (>41 vs≤40, only for axial disease) had only moderate agreement with MDA (achieved or not) (kappa=0.47, p=0.05 and kappa=0.469, p=0.072; respectively). All data were given n/total n (percentage (%)) or median (first-third percentiles)*. MDA: minimal disease activity; PsA: Psoriatic Arthritis; DIP: distal interphalangeal. Conclusions The MDA criteria provide an objective target for treatment in trials and clinical practice; however in real life PROs are the most significant barriers to achieve MDA within all domains. Leeds enthesitis index was not able differentiate MDA, for being negative in the vast majority of the patients. Monoarthritis subtype is a good prognostic factor whereas DIP joint disease and history of enthesitis are poor prognostic factors to achieve MDA. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) has a genetic background, approximately 40% of patients having a family history of psoriasis or PsA in first-degree relatives, which may impact the disease features. Objectives The aim of this study was to evaluate the effects of family history of psoriasis or PsA on the disease phenotypes. Methods The demographic and clinical data were retrieved from the longitudinal, multicenter PsArt-ID (Psoriatic Arthritis-International Database). Family history of psoriasis and PsA were investigated for 1st and 2nd degree relatives separately. The effect of the family history of psoriasis and/or PsA on disease phenotypes and severity were analysed, calculating the relative risks (RR). Results 1393 patients had the data for family history, 444 (31.9%) of whom was positive for psoriasis and/or PsA. The majority of the family history was only psoriasis (333/444; 75%) and 58.5% (260/444) of the patients had first-degree relatives affected. There was no differences in maternal or parental transmission rates however women had more psoriasis and/or PsA in their family (67.3% vs 32.7% p: 0.028). Patients with a family history had an earlier onset of age for psoriasis (29±14.8 vs 31±14.9 p: 0.007), more frequent nail involvement (50.7% vs 29.6% p: 0.032), more frequent enthesitis (28.2% vs 17.7% p Conclusions The family history of psoriasis and PsA has impacts on skin phenotypes, musculoskeletal features and the disease severity. The differences between family history of psoriasis and PsA and pustular vs plaque phenotypes may point out to a different genetic background and pathogenic mechanisms in these subsets. Disclosure of Interest None declared

Background Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of breast. Corticosteroids (CS) and immunosuppressive agents constitute treatment alternatives other than surgery. Objectives To evaluate the clinical characteristics and treatment responses of IGM patients followed up in our clinic. Methods The medical records of 70 IGM patients who were referred to Hacettepe University Rheumatology Clinic were examined. Forty-four patients who had at least one visit in the last 2 years were included in the analysis. Demographic, clinical and laboratory characteristics of the patients, treatments, clinical and/or ultrasonographically measured lesion sizes at the time of diagnosis and at the last follow-up were recorded. Complete and partial response in the last control visit were defined as ≥50% and Results Median age was 35.7 (24.3–57.2) years and median symptom duration was 2.5 (0.2–54.1) months at baseline. Palpable mass (90.9%) and breast pain (88.1%) were the most common symptoms. Skin fistules and axillary lymphadenopathy were present in 16 (37.2%) and 15 (34.1%) patients, respectively. Erythema nodosum was seen in 5 (11.4%) patients during follow-up. The median follow-up duration was 10.5 (1.05–99.6) months. CS monotherapy and combination of CS and immunosuppressive were used in 3 (7.8%) and 38 (86.4%) patients, respectively. Three patients were followed up without treatment. The first immunosuppressive agent was methotrexate (MTX) in 32 patients (84.2%) and azathiopurine (AZA) in 6 patients (15.7%). In one patient, MTX was switched to AZA due to hepatotoxicity. Treatment regimens and responses of the patients are summarised in table 1. IGM lesions disappeared in 24 patients at the end of follow-up. In two patients who were on MTX and KS, surgical excision was required because of unresponsiveness. Among relapsed patients (n=5), 2 patients were on MTX and KS, 1 patients was on AZA and KS and 2 patients were on KS at the time of relapse. In one patient, relapse was observed 1 year after cessation of MTX and KS. Conclusions In a case series previously published by our study group, the efficacy of the combined use of KS and immunosuppressant’s in IGM treatment was retrospectively studied.1 In this study, the efficacy of immunosuppressive therapy has been demonstrated with prospective approach. Reference [1] Konan A, et al. Breast Care2012;7:297–301. 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 SAPHO syndrome is a chronic disease with bone, joint and skin involvement characterised by synovitis, acne, pustulosis, hyperostosis and osteitis. It is a rare disease and its diagnosis may depend on detailed clinical examination as well as radiological evaluation Objectives In this study, we aim to present clinical features and diagnostic course of patients with SAPHO syndrome who are followed in our tertiary referral clinic. Methods All patients with SAPHO syndrome diagnosed since February 2014 have been registered with a standard form. Patients are prospectively monitored since then. Diagnosis was based on the criteria by Benhamou et al.. 1 In the questionnaire, demographic data (age, sex, duration of illness), clinical features (skin and joint involvement), laboratory characteristics (acute phase reactants, HLA-B27), radiological imaging (bone scintigraphy (increased activity in the sternum, bilateral sternoclavicular joints and clavicles), MRI) disease activity parameters (BASDAI, BASFI) were questioned. There were 24 patients with SAPHO syndrome. The data of 21 patients were presented because the clinical findings of 3 patients were insufficient. Results Data of 21 patients with SAPHO syndrome were available and 11 (52.4%) patients were female. Mean age at diagnosis was 39.9±12.9, mean age of symptom onset was 35.2±12.9, mean follow-up duration was 18.1±25.1 months. The mean delay time of diagnosis SAPHO syndrome was calculated as 49.0±82.5 months. Thirteen patients (61.9%) were followed up with another clinical diagnosis before SAPHO diagnosis. The clinical characteristics of the patients are shown in Figure 1. HLA-B27 was positive in 3 of 13 patients. Mean activity scores of our patients at initial visit were; BASDAI: 4.8±2.8, BASFI: 4.6±2.2, CRP2.3±4.2 mg/dL and erythrocyte sedimentation rate 23.8±22.6 mm/h. Scintigraphy findings were positive in 16 (94.1%) of 17 patients. The diagnosis of 2 patients was supported by MRI. The remaining 2 patients were diagnosed with X-ray and clinic findings. PPP: palmoplantar pustulosis, IBP: Inflammatory Back pain Conclusions There is a certain diagnostic problem in the SAPHO syndrome. Delay of SAPHO diagnosis was almost 4 years and 62% of patients had wrong diagnosis before SAPHO syndrome. Anterior chest wall involvement with dermatological findings should be alerting to the physicians. Bone scintigraphy can be helpful to diagnose SAPHO syndrome. It is important to distinguish SAPHO syndrome from other spondyloarthritis and/or psoriatic arthritis because of the potential different treatment strategies. Reference [1] Benhamou CL, Enjolras O, Delrieu F, Prier A, Camus JP, Amor B. Pseudoseptic arthritis and bacterid of Andrews [in French]. Rev Rhum Mal Osteoartic. 1984;51(4):229–231. Disclosure of Interest None declared

Background Adult onset Still’s disease (AOSD) is a rare, auto-inflammatory disease that commonly presents as fever of unknown origin (FUO), and most common rheumatologic cause of FUO. Clinical and/or laboratory parameters that can discriminate AOSD from other causes of FUO need to be clarified in current literature. Objectives To determine clinical and/or laboratory parameters that help to differentiate AOSD from other causes of FUO and demonstrating a clinician-friendly algorithm for this purpose. Methods Data from patients who admitted to Hacettepe University Hospitals, inpatients sections of department of internal medicine with the complaint of FUO, who eventually had a certain diagnosis, collected prospectively during 30 months. AOSD patients followed at Hacettepe University department of rheumatology were included. Clinical and laboratory data were collected at the time of diagnosis of AOSD and time of admission of patients with FUO. Results Total 156 patients (n=69, for AOSD; n=87, for FUO) were included. FUO group were also divided into three subgroups: rheumatologic (n=31, 35.6%), infectious (n=28, 32.2%) and malignant (n=28, 32.2%) causes. While 51 (74%) patients were female in AOSD group, 43 (49,4%) patients were female in FUO group (p=0.03). Frequency of rash, arthralgia, arthritis, sore throat, fever at night (p Conclusions Presence of arthralgia, hyperferritinemia, sore throat and neutrophilia strongly favour AOSD in patients presenting as FUO. This study demonstrates a clinician-friendly algorithm for the first time in current literature. Disclosure of Interest None declared

Background Digital ulcers (DUs) are common manifestations of vascular disease in systemic sclerosis (Ssc) patients. Objectives To investigate the association between the amount of oxygen delivered to periferal tissues and the development of DUs in SSc patients. Methods One hundred and eleven SSc patients (103 female) were recruited consecutively to the study. Thirty age and sex matched controls were also enrolled. Transthoracic echocardiography (TTE) was performed for each patient to estimate cardiac output (CO). Arterial oxygen saturation (SaO2) with pulse oximeter in room temperature and serum haemoglobin concentration (Hb) were measured at the time of TTE. The amount of oxygen delivered to tissues (D02) in 1 min was estimated using the equation D02=CO*(SaO2*1.39*Hb) and adjusted for body weight. Demographic, clinical and laboratory data were retrieved from hospital records. DUs were described as ulcerations on the skin distal to proksimal interphalangeal joints (PIF) of the digits. Patients were divided into 2 groups according to presence of DUs within 1 year of study enrollment (Group1=with DU, Group2=without DU). Chi-square and Mann-Whitney U tests were used for comparing categorical and continuous variables between the groups, respectively. Results Mean age was 52.6 (11.8) years in SSc patients and 51.3 (13.0) in controls. Median disease duration was 138.0 (1.8–415.2) months. Diffuse disease was present in 30.6% of patients. There were no differences in terms of Hb level, left ventricular ejection fraction (LVEF) and calculated D02 between SSc patients and controls. Mean CO was higher in healthy controls (6.1 vs. 5.1, p=0.004). Interestingly, mean S02 measurements was lower in control group (96.8 vs. 98.0, p=0.005). Comparison of demographics, disease characteristics, tissue oxygen delivery and relevant variables were summarised in table 1. When patients with active DUs were compared with patients without active DUs; no difference was found in Hb,S02, CO and D02 between groups. Conclusions Although the haemoglobin concentration was higher in the non ulcer group, there was no difference in the amount of delivered oxygen between patients with and without DUs. These findings imply that vasculopathy and/or peripheral artery disease plays a major role in the development of ulcers. Disclosure of Interest None declared

The author regrets that the original version of this article contained error. Figure 1 was shown in the wrong version, thus corrected figure is shown in this article.

Background Since majority of IgG4-related disease (IgG4-RD) patients in the literature are from Far East and United States, there is a lack of large series from other parts of the world. Objectives We aimed to identify the clinical characteristics and outcome of Turkish IgG4-RD patients from a tertiary center. Methods In step 1, clinical and histopathological features of patients having any disease under the clinical spectrum of IgG4-RD were retrospectively reviewed. For step 2, patients prospectively diagnosed are enrolled into the study. Patients fulfilling the “definite” diagnosis according to comprehensive diagnostic criteria were recruited (enrolled (n=52), excluded (n=47). Results Median age was 51.1 years and no gender predominance was observed (Male/female: 26/26). Retroperitoneal fibrosis is the most frequent presentation; others were lymphadenopathy, orbital pseudotumor, pancreas and salivary glands in decreasing order (Table). Twenty-four (46.1%) of patients had localized involvement. Corticosteroids were mainstay of treatment in 92.5% of patients, and in 57.5% with any immunosuppressive agents as first line treatment. Rituximab has been used for cases resistant to previous treatment or with relapses in 19 (47.5%) of patients. A complete response was achieved in 52.5% of patients and partial response ( Conclusions We observed similar features with previous European cohorts however no male predominance was seen. Even though conventional immunosuppressives were used in more than half of patients, treatment had switched to rituximab ∼50% patients owing to resistance or relapses. Disclosure of Interest None declared

Background Familial Mediterranean fever (FMF) is a periodic fever syndrome caused by MEFV mutations. FMF may be associated with psoriasis in some cases. Previous study has shown that psoriasis was more common in the relatives of FMF patients [1]. Objectives We aimed to investigate the prevalence of psoriasis among FMF patients and their relatives. Methods FMF patients followed at Hacettepe University Adult and Pediatric Rheumatology Departments between January and August 2016 were consecutively enrolled to this study. Demographic data, clinical manifestations, laboratory data and MEFV variant analysis were documented by medical file screening and face-to-face interview. The presence of psoriasis and psoriatic arthritis in patients and their relatives (first [Mother, father, children]-second [Brothers, grandchildren, grandfather and grandmother]-third degree [Nephew, uncle, maternal uncle, aunt, paternal aunt] relatives) and drug use history were also questioned. The patients were accepted to have psoriasis if the diagnosis was made by a dermatologist. Results 351 FMF patients (177 adults; 174 children) were included in this study (Table). 70.1% of adult patients were female, 29.9% were male. 53.4% of pediatric patients were female, 46.6% were male. The median age (min-max) of the adult patients was 35 (19–63), while the median age of the pediatric patient group was 10 (2–18). The onset age of symptom was 12 (0–39) in the adult group and 3 (1–14) in the pediatric group. The median age at diagnosis was 25 (2–52) in the adult group and 5 (1–18) in the pediatric group. Thirteen (3.7%) patients had psoriasis. Psoriasis was more common in adult patients than pediatric patients (p=0.02). Psoriasis was present in 22 (12.4%) of adult patients9 and 9 (5.2%) of pediatric patients9 relatives (p=0.023). The frequency of psoriasis in one or more relatives of all FMF patients was found to be 8.8%. Conclusions IL-1 has an essential role for signaling early T helper 17 (Th17) differentiation and Ashida et al have shown the presence of Th17 cells in the upper dermis of psoriasis-like lesions in a patient with FMF [2]. We may speculate that high IL-1 in FMF may cause Th17 activation and stimulation of keratinocytes; and this may be the reason for higher frequency of psoriasis in FMF patients. Thirteen (3.7%) patients had psoriasis; more common than the normal population (0.40%) (p References Barut, K., et al., Inceased frequency of psoriasis in the families of the children with familial Mediterranean fever. Clin Exp Rheumatol, 2016. 34(6 Suppl 102): p. S137. Ashida, M., et al., Psoriasis-like lesions in a patient with familial Mediterranean fever. J Dermatol, 2016. 43(3): p. 314–7. Disclosure of Interest None declared

Background Interstitial lung disease (ILD) is the leading cause of mortality in systemic sclerosis (SSc) patients. Treatment options are rather limited in SSc associated ILD (SSc-ILD). Objectives Objective of this study was to report the experience of RTX treatment in a series of patients with longstanding SSc-ILD in whom unsatisfactory response in lung functions was noted under conventional treatments. Methods We retrospectively reviewed charts of 197 SSc patients evaluated between April 2015 and November 2016. 14 patients who received rituximab (RTX) for SSc-ILD participated in this analysis. The severity of ILD based on PFTs was defined as follows; mild (FVC between 71% and 80% of predicted), moderate (FVC between 51% and 70% of predicted) and severe (FVC ≤50%). The extent of skin disease was clinically measured by using Modified Rodnan Skin Score (mRSS) tool. End of follow-up was considered as six months after the last RTX dose. Results Median (IQR, interquartile range) age was 53.2 (46.8–55.5) and median disease duration was 9.1 (5.1–13.6) years. Median FVC was 52.5 (41.5–64.0) prior to RTX. At the end of follow-up, no significant change was revealed in FVC when compared with pre-RTX values [58.0 (44.7–58.7), p=0.065]. FVC was improved in four patients and stabilized remaining ten patients. All of the patients with improvement of PFTs had moderate or severe restrictive lung disease. High resolution thorax computed tomography (HRCT) findings remained stable in 7 and showed progression of ILD in 3 patients. In total, mRSS remained stable at the end of follow-up when compared with baseline [8.0 (5.2–12.2) vs. 6.0 (4.0–12.2),p=0,026]. Conclusions In this case series of SSc patients treated with RTX, improvement or stabilization of pulmonary functions was observed in most of SSc patients. RTX may be useful in SSc-ILD patients with longer disease duration and resistant to conventional immunsupresive therapies. Disclosure of Interest None declared

Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disorder in childhood and more than one-third of patients have active inflammation during adult years that can cause disability. Objectives To define the demographic and clinical characteristics of non-systemic JIA (ns-JIA) patients under biological therapy followed in adult rheumatology department. Methods Hacettepe University Biologic Registry (HUR-BIO) is a single center biological registry since 2005. HUR-BIO database includes demographic and clinical characteristics of patients, disease activity parameters, history of articular prosthesis. The use of biological agents in routine rheumatology practice has been approved by the Ministry of Health since 2003. Results In this study, 95 (72.6% women) ns-JIA patients were included. The demographic and clinical characteristics of the patients were shown in the table. The first biological agents were; Etanercept (63.2%), adalimumab (16.8%), infliximab (12.6%) and the others 7 (7.4%). After a mean follow-up of 60 (48) months, 42 (44.2%) patients required biologic switch. The last visit HAQ scores of 75 patients were known and 16 (21.3%) patients had HAQ score ≥1.0 (female 15/54 vs. male 1/21, p=0.029). The last visit DAS-28 score of 72 patients was known and 46 (63.9%) patients had remission or low disease activity. 14 patients (14.7%) had history of articular prosthesis and were all female. Patients with history of articular prosthesis were older [39.1±10.1 vs. 29.6±10.3 years, p Conclusions Structural damage and history of articular prosthesis was more common in female ns-JIA patients receiving biological therapy. Functional disability and disease activity were also higher in female patients. On the other hand, the follow-up ns-JIA patients had a good level of remission and low disease activity.The shorter duration until the time of biological treatment in patients diagnosed after 2003 indicates that both pediatric and adult rheumatologists have begun to treat these patients more effectively. Disclosure of Interest None declared