Abdullah Dagli

Lamivudine and interferon-alpha combination treatment of childhood patients with chronic hepatitis B infection.

BACKGROUND The aim of our study was to compare the efficacy of combined interferon-alpha and lamivudine in children with chronic hepatitis B infection and two durations of treatment (6 and 12 months). METHODS Combination of interferon-alpha 2b (10 MU/m2 of body surface) and lamivudine 4 mg/kg (maximum, 100 mg) were given synchronously to 30 patients for 6 months (Group 1) and to 27 patients for 12 months (Group 2). Biochemical, virologic and serologic features were compared between two groups at the end of therapy and 6 months after therapy. RESULTS Hepatitis B e antigen clearances were 33 and 59% at the end of treatment and 37 and 56% 6 months after therapy in Groups 1 and 2, respectively (P > 0.05). Hepatitis B virus DNA clearances were 97 and 100% at the end of treatment and 97 and 96% 6 months after therapy in Groups 1 and 2, respectively (P > 0.05). In both groups normalization of alanine aminotransferase was maintained at the end of therapy and 6 months after therapy (P < 0.05). Sustained complete responses were obtained in 20 and 37% of patients at the end of therapy and 6 months after therapy, respectively (P = 0.07). CONCLUSIONS When the combination of large dosage interferon-alpha 2b and lamivudine therapy in children was compared at the end of therapy and 6 months after therapy, normalization of alanine aminotransferase and the clearances of hepatitis B e antigen and hepatitis B surface antigen in both groups were directly proportional to the duration of treatment. However, the higher complete response rate at 12 months of combination therapy was not statistically different from that at 6 months.

Combination therapy for children with chronic hepatitis B virus infection

Background and Aim: To compare the therapeutic efficacy of two different interferon (INF)‐α and lamivudine (LAM) combination therapy regimens in childhood chronic hepatitis B (CHB) infections.

Failure of therapeutic vaccination using hepatitis B surface antigen vaccine in the immunotolerant phase of children with chronic hepatitis B infection

Summary Aim:  The aim of this study was to investigate the efficacy of specific hepatitis B virus (HBV) vaccination as active immunotherapy in treating chronic hepatitis B (CHB) infection during the immune‐tolerant phase in children with normal aminotransferase levels and high viral load.

Comparison of treatments of chronic hepatitis B in children with lamivudine and α-interferon combination and α-interferon alone

Background : The aim of this study was to compare the efficacy of the α‐interferon treatment with treatment using α‐interferon and lamivudine in combination for cases of childhood chronic hepatitis B infection.

Comparison of ASDAS and BASDAI as a measure of disease activity in axial psoriatic arthritis

The aim of this study was to compare the discriminative ability of Ankylosing Spondylitis Disease Activity Score (ASDAS) with Bath Ankylosing Spondylitis Activity Disease Activity Index (BASDAI) and other clinical disease activity parameters in patients with axial psoriatic arthritis (axPsA). Patients with axPsA were recruited from Erciyes Spondyloarthritis Cohort (ESPAC) and Anatolian Group for the Assessment in Rheumatic Disease (ANGARD) cohort and were assessed for BASDAI, ASDAS, BASFI (Bath Ankylosing Spondylitis Functional Index), Ankylosing Spondylitis Quality of Life (ASQoL), and visual analog scale (VAS) pain. The discriminant ability of ASDAS-C-reactive protein (−CRP) and ASDAS-erythrocyte sedimentation rate (−ESR) was assessed using standardized mean differences between patients with high and low disease activity. Fifty-four patients with axPsA were included in the study. Both ASDAS scores showed good discriminative ability between high and low disease activity states. Both ASDAS versions and BASDAI had relatively high area under the curve (AUC) according to ASAS partial remission, patient and physician global assessments in receiver operating characteristic (ROC) curve analysis. There was no significant difference between AUC scores for the models that compared ASDAS-CRP and ASDAS-ESR with BASDAI for each individual definition of disease activity states. ASDAS versions and BASDAI showed good similar discriminative ability between high and low disease activity as reflected by the AUC analysis in axPsA. The cutoff values for inactive disease and high disease activity were relatively similar to predefined cutoff values for AS. Further, prospective validation is now required to identify the appropriate assessment tools and cutoff values in axPsA.

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

Background. Our aim was to determine the prognostic factors effective in the response to steroid treatment and relapse frequency. Patients and Methods. In this study, we evaluated 84 children with idiopathic nephrotic syndrome followed-up from 1997–2002. The variables were analyzed with respect to medical history, physical examination, laboratory findings, response to treatment, and factors associated with remissions and relapses. Our study group consisted of 62 children with minimal change nephrotic syndrome (MCNS), 11 children with focal segmental glomerulosclerosis (FSGS), and 11 children with diffuse mesangial proliferation (DMP). Results. According to response to steroids; 57.1% were steroid-sensitive with infrequent relapses, 22.6% were steroid-dependent with frequent relapses, and 20.2% were steroid-non-responders. Significantly high non-responder ratios to steroids were found in children with initial hypertension and hematuria (p < 0.05). Although patients older than six years were found to be associated with steroid non-response (p < 0.05), the number of relapses were found to be increased with an increasing number of infections (p < 0.05). The time period for the first relapse was found to be statistically correlated with relapse numbers of the first 6 (p = 0.001) and 12 (p = 0.01) months. Conclusion. The time span between initial presentation and remission and the number of infections were significant for relapse frequency. The existence of hematuria and hypertension and age greater than 6 years at initial presentation were associated with steroid non-responsiveness. The likelihood of developing resistance to the treatment should be emphasized early to the parents of patients bearing these risk factors, and hence the possible disappointment in the family should be prevented.

Gender specific differences in patients with psoriatic arthritis

Abstract Objectives: To assess gender related differences in a cohort of patients with psoriatic arthritis (PsA). Methods: Consecutively recruited patients were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms. Results: Women (n = 115) with PsA had higher symptom duration and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), Erythrocyte sedimentation rate (ESR) and poorer physical activity and fatigue than men (n = 72) with PsA. Psoriasis area and severity index (PASI) were higher in male patients. However quality of life (SF36 physical and mental component scores), articular pattern, extra-articular features (including uveitis, iritis) and family history for psoriasis, spondyloarthritis (SpA) (PsA and ankylosing spondylitis [AS]) were quite similar between men and women. Conclusions: Some of the clinical and laboratory variables tend to be different between men and women with PsA. The extent of quality of life and articular pattern seem to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations.

AB0751 The differences and similarities between patients and physician global assessment in patients with psoriatic arthritis

Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, axial involvement, enthesitis, dactylitis and uveitis. The differences and similarities between patients global assessment (PtGA) and physicians global assessment (PhGA) were not assessed clearly in PsA. Objectives The aim of this study was to assess differences and similarities between patients and physicians perspective of global assessment in patients with PsA. Methods Patients with PsA over the age of 18-year-old who met the CASPAR classification criteria were underwent clinical and laboratory evaluation by using standardized protocol and case report form, from two universities outpatients clinics. PtGA and PhGA, VAS-pain, fatigue, BASDAI, BASFI, health-related QoL were recorded at baseline visit. Pearson correlation coefficient were calculated for PtGA and PhGA. Linear regression model were used to asses relationship between global assessments and clinical finding. Results A total 144 patients with PsA (male 51, female 93) were included. Symptom duration (7.8±7.5 vs 11.3±11.2), VAS-pain (4.4±2.6 vs 4.9±2.6), PtGA (4.7±2.5 vs 5.0±2.4) and PhGA (4.0±2.2 vs 4.4±2.2) were similar between male and female patients with PsA (p>0.05). VAS-fatigue was higher in female patients with PsA than male ones (5.9±2.7 vs 4.4±2.8, p=0.001). Disease activity measurements such as, tender and swollen joint count, DAS28, BASDAI and acute phase reactant were similar for both sex. Correlation coefficient of Physicians global assessment was higher than PtGA in various clinical findings. The highest correlation coefficient was observed in VAS-pain (r=0.784) and followed by SF36-bodily pain (r=-0.613), BASDAI (r=0.587), NHP-physical activity (r=0.584), VAS-fatigue (r=0.555), BASFI question 5 (r=0.551) for PhGA (p<0.0001). However the highest correlation coefficient was observed in VAS-pain (r=0.690) and followed by NHP-physical activity (r=0.536), BASFI question 10 (r=0.512), BASDAI (r=0.499), SF36 (r=-0.490) and BASFI total score (r=0.484) for PtGA (p<0.0001). Statistically significant positive linear relation was observed between global assessment and clinical parameters (VAS-pain, fatigue, BASDAI, BASFI, DAS28, NHP-physical activity) by using simple linear regression model. VAS-pain and BASDAI question 1 explained 83.3% of PtGA as a predictor in multiple linear regression model. However, VAS-pain and DAS28 explained 68.4% of PhGA as a predictor in multiple linear regression model (table 1).Table 1. Results of multiple linear regression of PtGA and PhGA R2 B SE t p Patients global assessment  Constant 0.833 0.597 0.311 1.920 0.060  VAS-pain 0.665 0.061 10.939 ?0.0001  BASDAI-1 How would you describe the overall level of fatigue/tiredness you have experienced in the past week? 0.205 0.063 3.243 0.002 Physicians global assessment  Constant 0.684 0.399 0.310 1.285 0.201  VAS-pain 0.587 0.050 11.846 ?0.0001  DAS 28 0.332 0.096 3.453 0.001 Conclusions Assessment of disease activity as well as clinical parameters is considered to be complex in PsA. Patients and physicians have different perspective of disease activity. Severity of pain and fatigue may be predictor of PtGA whereas; pain and objective disease activity measurement may be predictor of PhGA in patient with PsA. Disclosure of Interest None declared

SAT0646-HPR Women with Psoriatic Arthritis Who Are Homemakers or Office Workers Declare Similar Difficulties during Working: Table 1

Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis. The differences between homemaker (HM) and working at paid work (PW) in women were not assessed. Objectives The aim of this study was to assess differences between being HM and working in PW in female patients with PsA related to clinical findings, quality of life and difficulties at working. Methods Female patients with PsA over the age of 18-year-old who met the CASPAR classification criteria were underwent clinical and laboratory evaluation by using standardized protocol and case report form, from three different universities outpatients clinics. Female patients with PsA were divided into age matched two group as a HM or working in PW. Patients who were HM or PW were asked to mark their level of difficulty during household works or office works respectively, on a 0–10 Likert scale. 0, indicated no difficulty during household/office works; 10, unable to do household/office works because of PsA and high scores indicated more difficulty. Results A total of 115 female patients with PsA (mean age 41.9±11.9 year) were included. Mean symptom duration was 10.7±9.3 year. Out of 86 (74.8%) patients with PsA were HM and 29 (25.2%) were working at a regular PW. Homemaker had higher body mass index than PW (25.1±7.4 vs 29.7±6.6 p=0.012). Dactylitis (current or having history) were higher in PW (58.6 vs 31.4% p=0.014) whereas enthesitis (current or having history) were higher in HM (27.6 vs 52.3% p=0.021). Disease activity measures (acute phase reactants, BASDAI, DAS28, VAS-pain, physicians and patients global assessment, tender and swollen joint count), functional status and health related quality of life assessments (BASFI, BASMI, Duruoz hand index, SF-36, Nottingham health profile, psoriatic arthritis quality of life, hospital anxiety and depression scale, fatigue severity scale) were similar between HM and PW patients with PsA (p>0.05). Level of difficulties in working at household works were 5.2±2.6 in HM and level of difficulties in office works were 5.3±2.3 (p=0.804) in PW. Depression risk (HAD-depression ≥7) was relatively higher in PW (59.3 vs 43.7%), but anxiety risk (HAD-anxiety ≥10) was relatively higher in HW (26.8 vs 22.2%) (p>0.05). Fatigue severity scale score≥36 was associated with depression risk in all women with PsA by using univariate logistic regression analysis (OR: 5.1, 95% CI: 2.0–12.8 p<0.0001).Table 1 Working at PW (n=29) HM (n=86) p Age 40.4±12.7 42.3±11.2 0.481 Number of pregnancies 3.6±3.6 4.4±2.6 0.354 Difficulties in household/office work (0–10) 5.3±2.3 5.2±2.6 0.804 Dactilitis (current or having positive history) 17 (58.6) 27 (31.4) 0.014 Tenosynovitis (current or having positive history) 8 (27.6) 25 (29.1) 0.887 Enthesitis (current of having positive history) 8 (27.6) 45 (52.3) 0.021 BASDAI 4.4±2.3 4.0±2.5 0.506 DAS 28 4.0±1.4 4.0±1.7 0.992 PsAQoL 7.4±6.5 6.2±5.7 0.530 HADS - - Depression 6.8±3.7 6.8±4.0 0.945 HADS – Anxiety 5.9±4.9 6.6±4.3 0.529 Fatigue severity scale 3.9±1.5 3.9±1.0 0.561 Conclusions Women with PsA who were homemakers or working in paid work do not differ from each other in terms of disease burden, health related quality of life, difficulties at homework or at office work.Furthermore, increased fatigue may be associated with depression risk in female patients with PsA. Disclosure of Interest None declared

AB0825 Gender Specific Differences in Patients with Psoriatic Arthritis

Background Psoriatic arthritis (PsA) has been defined as an inflammatory arthritis associated with psoriasis. Gender specific differences regarding the clinical picture and burden of the disease is unclear in PsA. Objectives To assess gender related differences in a cohort of patients with PsA. Methods Consecutively recruited patients (from five university hospitals) who met CASPAR criteria, age more than18 years were included and underwent clinical, radiological and laboratory evaluation by using standardized protocol and case report forms. Results A total of 187 patients with PsA (72 male; 115 female) were analyzed. Women with PsA had higher symptom duration (beginning of articular symptoms) and body mass index (BMI), tender and swollen joint counts, disease activity score-28 joints (DAS28), ESR, physical activity and fatigue component scores of Nottingham Health Profile (NHP) scores than men with PsA (Table). Psoriasis area and severity index (PASI) was higher in male patients. However quality of life (SF36 physical and mental component scores) and psychological distress measures were quite similar between men and women. Some of the extra-articular features (including uveitis, iritis) and family history for psoriasis, PsA and ankylosing spondylitis did not differ between genders. Articular involvement patterns were not different between men and women (in %, asymmetrical oligoarthritis 51.4 vs 48.7, symmetrical polyarthritis 15.3 vs 17.4, DIP 6.9 vs 13.9, arthritis mutilans 5.6 vs 5.2, axial 20.8 vs 14.8, respectively, p=0.547).Table 1 Male (n=72) Female (n=115) p mean ± SD mean ± SD Age 43.8±13.6 41.9±11.6 0.309 BMI 25.9±3.8 28.5±7.0 0.001 Symptom duration, years 7.5±6.8 10.2±9.1 0.023 Diagnostic delay, years 1.3±2.4 1.9±5.8 0.314 Duration psoriasis-arthritis, months 111.0±113.5 72.1±80.0 0.014 Pain-VAS 4.3±6.0 4.6±2.6 0.647 Patients global 4.4±4.1 4.6±2.8 0.751 Tender joint count 4.6±7.9 8.2±10.8 0.010 Swollen joint count 0.9±1.7 2.0±4.4 0.015 PASI 15.8±21.2 8.3±11.9 0.035 DAS28-CRP 3.1±1.4 4.0±1.6 <0.0001 ESR (mm/h) 18.6±19.0 26.2±19.1 0.009 CRP (mg/l) 7.3±11.5 6.9±11.5 0.811 Duruoz Hand Index (DHI) 6.1±13.6 9.9±14.8 0.079 NHP-physical activity 24.7±21.8 32.7±27.7 0.032 NHP-fatigue 30.0±37.7 49.4±41.6 0.001 HAD-depression 6.9±4.0 6.8±3.9 0.829 HAD-anxiety 6.3±4.0 6.4±4.5 0.844 PsAQoL 5.8±5.5 6.5±5.9 0.423 Conclusions Some of the clinical and laboratory variables tent to be different between men and women with PsA. The extent of psychological distress, pain, quality of life and pattern of joint involvement tent to be similar in both genders. Men with PsA are more likely to have higher PASI scores and longer duration to develop arthritis after the onset of psoriasis, while women are more likely to have higher disease activity and report more fatigue and physical activity limitations. Disclosure of Interest None declared