Emre Bilgin

Comparing polyarteritis nodosa in children and adults: a single center study

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of medium/small arteries. We aimed to examine the characteristics of adult‐ and childhood‐onset PAN.

Increased cancer risk in patients with periodontitis

Abstract Background: Previous studies have noted a possible association between periodontal diseases and the risk of various cancers. We assessed cancer risk in a cohort of patients with moderate to severe periodontitis. Methods: Patients diagnosed with moderate to severe periodontitis by a periodontist between 2001 and 2010 were identified from the hospital registry. Patients younger than 35 years of age or with a prior cancer diagnosis were excluded. The age- and gender-standardized incidence rates (SIR) were calculated by dividing the number of observed cases by the number of expected cases from Turkish National Cancer Registry 2013 data. Results: A total of 280 patients were included (median age 49.6, 54% female). Median follow-up was 12 years. Twenty-five new cancer cases were observed. Patients with periodontitis had 77% increased risk of cancer (SIR 1.77, 95% CI 1.17–2.58, p = .004). Women with periodontitis had significantly higher risk of breast cancer (SIR 2.40, 95% CI 0.88–5.33) and men with periodontitis had significantly higher risk of prostate cancer (SIR 3.75, 95% CI 0.95–10.21) and hematological cancers (SIR 6.97, 95% CI 1.77–18.98). Conclusion: Although showing a causal association necessitates further investigation, our results support the idea that periodontitis might be associated with increased cancer risk, particularly with hematological, breast and prostate cancers.

AB0641 Comparing the Characteristics of Adult and Pediatric Patients with Polyarteritis Nodosa

Background Polyarteritis nodosa (PAN) as a necrotizing vasculitis of medium or small arteries without glomerulonephritis or vasculitis in arterioles, venules or capillaries and not associated with antineutrophil cytoplasmic antibodies. It is more common in middle-aged adults when compared with children. Objectives The aim of this study was to examine and compare the clinical characteristics of adult and pediatric patients with PAN. Methods Six pediatric (<18 years of age) and ten adult patients with a clinical diagnosis of PAN who were seen at the Departments of Rheumatology and Pediatric Rheumatology, Hacettepe University, Ankara, Turkey were included in the study group. The pediatric and adult patients were classified as PAN according to the Ankara 2008 and American College of Rheumatology (ACR) 1990 criteria, respectively. The clinical features and response to therapy were evaluated retrospectively. Results The characteristics of PAN patients were summarized in Table 1. According to the results with a statistical significance, female/male ratio was higher in children; neurologic and renal involvements were more common and the duration of induction treatment was longer in adults. 2/10 adult and 3/6 pediatric patients had accompanying familial Mediterranean fever. Ninety percent of adult patients had received cyclophosphamide plus corticosteroid for induction treatment while four pediatric patients received CYC and two received mycophenolate mofetil besides corticosteroid treatment. Conclusions Our study, although the number is limited, have shown that neurologic and renal involvement were more common in adults with PAN and the duration of induction treatment was longer when compared with pediatric patients. There is no previous study comparing the characteristics of pediatric and adult patients with PAN; however, according to the previous studies, juvenile PAN has a more benign course than adult onset PAN. Multicenter collaboration remains essential to determine the characteristic features of PAN in patients of different age groups. References Eleftheriou D, Batu ED, Ozen S, Brogan P. Vasculitis in children. Nephrol Dial Transplant 2014 Dec 30. pii: gfu393. [Epub ahead of print]. Ozen S, Pistorio A, Iusan SM, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010;69:798-806. Lightfoot RW Jr, Michel BA, Bloch DA, et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 1990;33:1088-1093. Disclosure of Interest None declared

Increased psoriasis frequency in patients with familial Mediterranean fever

Abstract Objective: Familial Mediterranean fever (FMF) is a periodic fever syndrome caused by MEFV mutations. FMF may be associated with psoriasis in some cases. The prevalence of psoriasis in the normal Turkish population is 0.42%. 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 included. FMF patients/their relatives were accepted to have psoriasis if the diagnosis was made by a dermatologist. Results: A total of 351 FMF patients (177 adults; 174 children) were included. The median (min–max) age of adult and pediatric patients was 35 (19–63) and 10 (2–18) years, respectively. Thirteen (3.7%) FMF patients (11 adults, 2 children) had psoriasis. Psoriasis was more common in adult than pediatric patients (p = 0.02). Psoriasis was present in 22 (12.4%) of adult and 9 (5.2%) of pediatric patients’ relatives (p = 0.023). The frequency of psoriasis in ≥1 relatives of FMF patients was found to be 8.8%. Abdominal pain and fever were significantly higher, and arthralgia, arthritis, pleural chest pain, and pericarditis were significantly less frequent in the pediatric group than in adults (p < 0.05). Conclusion: Psoriasis was more common in FMF patients than in the normal population. Thus, FMF patients should be questioned and carefully examined for psoriasis lesions and psoriasis family history. Prospective multicenter studies may be important to find the incidence of psoriasis in FMF.

Remission of relapsing polychondritis after successful treatment of myelodysplastic syndrome with azacitidine: a case and review of the literature

Abstract Background: Relapsing polychondritis (RP) is a rare autoimmune disorder, and myelodysplastic syndrome (MDS) is accompanied by RP at variable rates. Herein, we report a case with RP and MDS who responded dramatically to 5-azacitidine for MDS. Case presentation: With conventional immunosuppressive treatment, our patient had several episodes of different side effects, including infections. With the diagnosis of MDS and initiation of azacitidine treatment, all the manifestations of RP disappeared, and remission was achieved for MDS. Although he had relapses of either RP or MDS after several years of azacitidine treatment, all relapses were controlled well with the initiation of azacitidine treatment every time. Conclusions: Azacitidine should be kept in mind as a treatment option for RP patients with MDS.

Poor outcomes among elderly patients hospitalized for influenza-like illness

Abstract Background and objective: Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015–2016 influenza season in selected hospitals in Turkey. Patients and methods: The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24–48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods. Results: Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode. Conclusion: These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.

Blood group ‘A’ may have a possible modifier effect on familial Mediterranean fever and blood group ‘0’ may be associated with colchicine resistance

Aim/purpose: Our aim was to investigate the association between blood groups and colchicine resistance in familial Mediterranean fever (FMF) patients. METHODS This is a single-center, cross-sectional study. Between January and December 2016, 385 FMF patients were assessed by the Adult and Pediatric Rheumatology outpatient clinics and 297 patients had blood groups (ABO and Rh) results. The patients were grouped into two groups: colchicine-responsive patients (Group CR) and colchicine-unresponsive patients (Group CUR). RESULTS Patients with blood group A had 1.5-fold higher FMF compared with non-A blood group (OR: 1.50 [95% CI: 1.11-1.87]), particularly having a Rh (+) blood group (OR: 1.47 [95% CI: 1.13-1.91]). Furthermore, patients with blood group A had a better response to colchicine treatment than non-A blood group; (OR: 2.21 [95% CI: 1.15-4.27]). Patients with blood group O were prominently associated with colchicine resistance. CONCLUSION ABO blood phenogroups may be used in combination with other risk factors to identify FMF patients and patients at high risk for colchicine resistance.

SAT0608 How to differentiate adult onset still’s disease from overall other causes of fever of unknown origin: results of a prospective study from a tertiary referral centre

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<0.001 for each), history of hemophagocytosis (p=0.037) were significantly higher in AOSD group. Fever peak number equal and/or higher than 3, presence of lymphadenopathy (p=0002 and p=0,001,respectively) were significantly higher in FUO group. While leukocytosis, neutrophilia, thrombocytosis, hyperferritinemia, higher lactate dehydrogenase and complement 3 levels (p<0.001 for each) were significantly more frequent in AOSD group, albumin levels lower than 3 g/dl and positive rheumatoid factor (p=0.009 and p=0.002,respectively) were significantly more frequent in FUO group. Results of univariate and multivariate analysis are given in table 1. Algorithm for discrimination of AOSD and FUO is given at Abstract SAT0608 – figure 1.Abstract SAT0608 – Table 1 Results of univariate and multivariate analysis Univariate Analysis Multivariate Analysis Variables Odds Ratio Confidence Interval p value Odds Ratio Confidence Interval p value Favours Still’s Fever at night 7,66 3,53–16,5 <0001 Rash 10,08 4,80–21,2 <0001 31,3 3,6–271,9 0002 Arthritis 6,58 3,09–14,01 <0001 Arthralgia 36 10,46–123,8 <0001 158,1 4,3–5755,8 0006 Sore throat 27,72 11,58–66,33 <0001 20,8 2,8–154,7 0003 Hemophagocytosis 4,79 0,96–23,89 0079 Neutrophilia 10,87 4,90–24,13 <0001 18,4 2,6–132,3 0004 Ferritin≥5 x UNL 4,88 2,34–10,16 <0001 132,8 7,1–2502,9 0001 LDH 7,12 2,35–21,59 <0001 6,2 0,76–50,9 0087 C3 3,20 1,47–7,00 0003 Female 2,90 1,46–5,73 0002 Favours FUO Pleuritis 2,04 0,68–6,12 0,19 Fever peak number≥3 3,66 1,16–11,52 0019 69 2,2–2114,4 0015 Lymphadenopathy 3,39 1,72–6,79 <0001 UNL: Upper normal limit (for ferritin: 336 ng/ml) 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

The association of various social capital indicators and physical activity participation among Turkish adolescents

Background Physical activity participation (PAP) has been proven to improve health and promote optimal growth among adolescents. However, most adolescents do not meet the current physical activity (PA) recommendations in Turkey. The role of the social environment and social factors on PAP is being increasingly recognized. Although social capital (SC) indicators have been examined in high-income countries, there are few studies on developing countries. The aim of this study was to examine the relationship between SC indicators and PAP among Turkish adolescents. Methods A survey was conducted among 19 high schools in 4 different cities in Turkey in 2016. A total of 506 female and 729 male high school students participated in this study. The dependent variable was overall PAP, which was measured using the short form of the International Physical Activity Questionnaire. The independent variables included self-perceived family, neighborhood, and school SC. Self-rated health and obesity status, measured by body mass index, were other study covariates in multiple binary logistic regression models. Chi-square tests were used to assess the differences between genders. Results PAP levels were significantly different between males and females. A higher percentage of males reported PAP (77.4%) compared to females (51.0%). Among males, teacher–student interpersonal trust and informal social control were inversely associated with PAP, while high students interpersonal trust was positively associated with increased odds of PAP. For females, students interpersonal trust was inversely associated with PAP. Conclusion Various SC indicators are associated with PAP for males and females. These associations are different from findings of studies conducted in developed countries. Therefore, health-promotion interventions and policies should consider gender and different social agents on the social and cultural background to improve PAP among Turkish adolescents.

AB0562 Demographic Characteristics and Distribution of The Vasculitides Frequencies: A Real- Life Experience of Vasculitis Center from Eastern Mediterranean

Background Vasculitides are a heterogeneous group of diseases. The distribution of the type of vasculitis changes not only with age and sex but according to the geographic area as well. The prevalence of each vasculitis is important in guiding the local medical education and raising awareness of doctors and policy makers etc. Objectives This study is aimed to present the distribution of vasculitides in the Pediatric and Adult Vasculitis patient Groups. Methods Hacettepe University is one of the main referral centers in the country. Executive committee of our Vasculitis center consist of physicians from Pediatric and Adult Rheumatology, Nephrology, Radiology and Pathology Departments. Multidisciplinary approach improves management of our patients. All patients starting from October 2014 have been included and defined according to the 2012 revised Chapel Hill nomenclature criteria. Results A total of 882 patients had been newly diagnosed/followed in this period. 205 (23.2%) of them were pediatric patients. The leading vasculitis among adult patients was Behcets Disease whereas in pediatric patients it was HSP (Figure). More than half of the adult Behcets patients (58.4%) had uveitis/neurologic/vascular involvement. Takayasu arteritis was more frequent than giant cell arteritis among the adult patients. There was a female predominance in patients with large vessel vasculitis. Granulomatous polyangiitis was the most common small vessel vasculitis in adults. Finally 23 adult cases of Immunglobulin G4 related disease have been seen.Table 1. Demographic characteristics of each vasculitis Adult patients Pediatric patients Mean age (SD) Mean age (SD) Behçets disease 42.8 (12.9) 11.8 (4.0) Female, % 52.5% 46.1% Takayasus arteritis 38.9 (14.2) 14.3 (4.1) Female, % 91.6% 100% Giant cell (temporal) arteritis 69.5 (8.2) – Female, % 74.2% Poliarteritis nodosa 40.1 (15.3) 11.3 (7.3) Female, % 39.1% 50.0% Kawasaki disease – 4.7 (3.0) Female, % 26.4% Eosinophilic granulomatosis with polyangiitis 52.9 (19.3) 10 Female, % 60% 100% Granulomatosis with polyangiitis 54.1 (15.9) 8.5 Female, % 46.5% 50% IgA Vasculitis (Henoch-Schoenlein purpura) 38.3 (18.5) 7.3 (4.9) Female, % 46.1% 47.7% IgG4related disease 47.8 (17.8) – Female, % 52.2% Others (secondary vasculitis, Buerger, cryoglobulinemic vasculitis, aortitis, etc.) 47.4 (15.6) 13 (5.1) Female, % 50% 50% Conclusions We describe the demographic characteristics and distribution of vasculitides in the eastern Mediterranean. Behcets disease has a high frequency as expected. Also Takayasu arteritis is more frequent than Giant cell arteritis. Microscopic polyangiitis is very rare. Among children Kawasaki was less and Behçet disease markedly more when compared to western Europe figures. The observed differences may be due to genetic modifiers or environmental factors. Disclosure of Interest None declared