F. Onen

A Large‐Scale Outbreak of Trichinellosis Caused by Trichinella britovi in Turkey

An outbreak of trichinellosis occurred in Izmir, Turkey, between January and March 2004. The outbreak was caused by the consumption of raw meat balls made of beef deceptively mixed with pork infected with Trichinella britovi. A total of 1098 people who had consumed this food either in 14 restaurants or from the street vendors located in three different neighbourhoods, consulted six different healthcare centres with a wide range of clinical signs and symptoms. Of them, 418 (38.1%) patients fulfilled the criteria for the diagnosis of acute trichinellosis. The most commonly observed signs and symptoms were myalgia (89.2%), arthralgia (69.9%) and eyelid (67%) and facial oedema (65.8%). High levels of creatinine kinase (69.3%) and lactate dehydrogenase (93.8%) with leucocytosis (>10 000/mm3, 58.9%) and eosinophilia (>1000/mm3, 60.5%) were the most prominent laboratory findings. All, but 13 of these patients were treated with mebendazole or albendazole. Based on the physicians’ assessments of disease severity, 78 (19%) patients were additionally given prednisolone in whom a significantly more rapid recovery of clinical signs and symptoms (e.g. fever, myalgia, facial and eyelid oedema) was observed, with a rapid improvement in leucocytosis, eosinophilia and muscle enzymes, compared with those, who had not received corticosteroids (P < 0.05). Beef illegally mixed with pork of unknown origin, by a wholesale butcher who had sold this product to restaurants and street vendors at a lower price than the prevailing market price of beef, was the cause of this large‐scale outbreak in a country with a predominantly Muslim population.

FREQUENCY AND SEVERITY OF MUSCULOSKELETAL SYMPTOMS IN HUMANS DURING AN OUTBREAK OF TRICHINELLOSIS CAUSED BY TRICHINELLA BRITOVI

Musculoskeletal symptoms such as myalgia are well-known features in the course of trichinellosis; however, the characteristics of musculoskeletal findings have been described in detail in only 1 study. The present study was aimed to determine the joint and muscle symptoms in subjects diagnosed with acute trichinellosis at our rheumatology unit during a Trichinella britovi outbreak that occurred in Izmir, Turkey, in 2004. In total, 98 patients (55 females, 43 males; mean age 32.3 ± 10.9 yr) were included in the study. A detailed history and full musculoskeletal examination were obtained in each patient. A self-administered questionnaire developed for recording the musculoskeletal symptoms was completed monthly until all the symptoms were resolved. Pain at the joints, restriction of movements (in shoulders, elbows, wrists, knees, ankles, and temporomandibular joints), myalgia, and muscle weakness (neck and shoulder girdle, muscles of the upper and forearm, back, thigh, and calf muscles) were assessed in every patient. Eosinophil counts, serum levels of creatine kinase, and lactate dehydrogenase also were analyzed. The most frequent musculoskeletal symptoms were muscle pain (86 cases [87.8%]), joint pain (83 [84.7%]), subjective muscle weakness (75 [76.5%]), and restriction of joint movements (63 [64.3%]). Calves, upper arm, neck and shoulder girdle, and forearms were the most affected muscle groups. Muscle pain was reported more frequently in the upper than in the lower extremities and during activity. The most frequent painful joints were shoulders, knees, wrists, and ankles. Upper extremity joints were affected more frequently than the lower extremity joints (77.6 vs. 70.4%). Joint pain occurred more frequently at rest. Both muscle weakness and restriction of joint movements were reported in and around the most frequently affected regions. No evidence of arthritis and objective muscle weakness was noted on physical examination in any patient. Musculoskeletal symptoms in the course of T. britovi infection are frequent but with an excellent prognosis. Joint pain in people suffering from acute trichinellosis may occur more frequently than reported previously.

The prevalence of gout in an urban area of Izmir, Turkey: a population-based epidemiological study.

This study aimed to determine the prevalence of gout in a general Turkish population, according to the American College of Rheumatology (Wallace) criteria proposed for gout classification.

A case of recurrent pancreatitis due to hyperlipidemia misdiagnosed as familial Mediterranean fever

Familial Mediterranean fever (FMF) is prevalent among Arabic, Turkish, Armenian, and Jewish people and it must always be considered in the differential diagnosis of patients from these ethnic groups presenting with recurrent abdominal pain with fever. In cases of fever and recurrent abdominal pain, acute pancreatitis is an important clinical condition, which should be considered in the differential diagnosis. Serum amylase concentration in acute pancreatitis is usually more than three times the upper limit of normal. However, in recurrent pancreatitis secondary to hypertriglyceridemia, serum amylase levels, for reasons that are not well understood, may be normal or mildly elevated. Recurrent pancreatitis secondary to hypertriglyceridemia may thus pose a problem in the differential diagnosis and may lead to an erroneous diagnosis of FMF. Measurement of serum triglyceride along with amylase levels should be required for a suspected diagnosis. Computerized examination of the abdomen may need to be undertaken to exclude acute pancreatitis in the presence of hypertriglyceridemia since serum amylase levels may be normal or slightly elevated.

SAT0184 The effect of smoking on response to tumor necrosis factor-alpha inhibitor treatment in ankylosing spondylitis patients: results from the turkbio registry

Background: Although there is good evidence that smoking has a dose-dependent impact on structural damage progression in ankylosing spondylitis (AS) the evidence is poor for its impact on disease activity, physical mobility, life quality and treatment response. Objectives: We aimed to investigate the impact of smoking on disease acitivity, treatment adherence and treatment response in Turkish patients with AS treated with their first tumour necrosis factor-alpha inhibitor (TNFi) therapy in a real-life cohort. Methods: 561 patients fulfilling the modified New York criteria for AS and treated with their first TNFi therapy since 2011 from 8 centers in Turkey were included in the analysis. Treatment response was evaluated as achievement of “BASDAI50” or “ASDAS Clinically important improvement (CII)” at the 3-months’ and 6 months’ visits. Clinical and demographic parameters were compared between current/never and current/previous smoker groups. Demographic and descriptive data are presented by medians/interquartile ranges (IQRs). Groups were compared by non- parametric tests (x2, Kruskal Wallis and Mann Whitney tests). Kaplan Meier plots, Cox and logistic regression analyses were calculated for treatment adherence and treatment response. Results: Among 561 AS patients included in the study, 506 (90%) had known smoking status (37% current, 35% never, 17% previous smokers). The median follow-up time was 1.9 years (IQR 0.85–3.5) and disease duration was 3.1 years (0,6–7,7). At baseline, current smokers were younger (34, IQR 29–41) compared with never (38, IQR 30–46 p=0.007) and previous smokers (42, IQR 34–49 p<0,001). Current smokers had male predominance (n=148, 43.9%; n=85, 25.2%); lower erythrocyte sedimentation rate (28 mm/h (13–42); 34 mm/h, (20–49) and higher change in BASMI (40, IQR 10–57.5; 10, IQR 4–30) compared with never smokers (all p<0.005). HLA status, body mass index, CRP, baseline disease indexes (BASDAI, BASFI, BASMI, HAQ, ASDAS) and treatment response was not found to be different between current and never smoker patients in our population (table 1). In multivariate analysis, male (OR:1,98; 95% CI (1,39–2,82), p<0,01), HLA positive (OR:1,54; 95%CI (1,08–2,18), p=0,016) and active DMARD user (OR:1,84; (95%CI 1,12–3,01) p=0,015) patients had better treatment response and treatment adherence ((HR:1,93; 95% CI (1,36–2,73); HR:1,60; 95% CI (1,13–2,27); HR:1,80; 95% CI (1,10–2,95) all p<0,005) but smoking status were not significant (p>0,05). Conclusions: In this study of TNFi-treated AS patients in clinical practice, smoking was not found to be associated with disease activity, treatment response and treatment adherence. Disclosure of Interest: None declared

AB0835 Comparison of long term anti-tnf survival in patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis; data from turkbio registry

Background Limited data are available on anti-TNF survival in non-radiographic axial spondyloarthritis (nr-axSpA) patients and their long-term survival in ankylosing spondylitis (AS). Objectives The aim of the study was to evaluate long term survival of the first anti-TNF drug treatment among patients with AS and nr-axSpA enrolled in the TURKBIO database and to compare the discontinuation rates for infliximab (INF), etanercept (ETN), and adalimumab (ADA) in each of the two groups. Methods All AS and nr-axSpA patients receiving biological therapies registered in the TURKBIO database between the dates of october 2011 and april 2017 were included in the study. AS diagnosis was made according to modified New York classification criteria and nr-axSpA according to ASAS AxSpA classification criteria. Demographic and clinical data, the date of starting to use biological drug, using frequency and dose of biological drugs, BASFI, BASDAI, BASMI, ASDAS scores, date and reason for discontinuing to use drug were collected. Baseline characteristics and drug survival rates were compared between AS and nr-axSpA patients. Drug survival was calculated by the Kaplan-Meier method and risk for discontinuation among treatment groups cpmpared by Long Rank test. Results A total of 924 patients were included in the study (AS, n=871 and nr-axSpA, n=53). More than half of the patients with AS were male (60.7% in AS vs 34.0% in nr-axSpA group, p<0.001).AS patients had longer symptom duration (104.90±79.06 vs 75.11±45.29 months, p<0.036) compared to nr-axSpA. Median levels of CRP and ESR were similar for nr-axSpA (CRP: 27.03±34.71, ESR: 30.50±25.77) and AS (CRP: 22.32±29.95, ESR: 35.40±22.91). The scores of BASFI, BASMI and ASDAS were found to be similar in both groups. Median BASDAI scores at first TNFi initiation were higher in patients with nr-axSpA than in patients with AS (58.65±18.21, 51.06±18.91, p=0.030). Cumulative drug survival rates did not show significant difference among INF (at 59. months:18,5%), ADA (at 71. months: 39,5%) and ETN (at 51. months: 24,2%) in nr-axSpA group (p=0,699) (figure 1). Similarly, drug survival rates at 78, 77, 78. months for 3 anti-TNF drugs had shown no difference in AS patients (INF (at 78. months: 38,1%), ADA (at 77. months: 52,4%), ETN (at 78. months: 39,0%)) (p=0,151) (Figure 2). Cumulative survival rates in AS patients (at 78. months:42,2%) were found to be significantly higher than that (at 71. months:28,2%) in nr-axSpA patients (p<0,001) (Figure 3).Abstract AB0835 – Figure 1 Drug survival rates anti-TNF in nr-axSpA. Abstract AB0835 – Figure 2 Drug survival rate by anti-TNF in AS. Abstract AB0835 – Figure 3 Overall drug survival on first anti-TNF in nr-axSpA and AS patients. Conclusions In contrast to the literature that revealed similar short term survival rates for anti-TNF drugs in patients with AS and nr-axSPA, we found higher survival rates in patients with AS compared to patients with nr-axSpa in this long-term observational study.A limitation of the study may be the low number of nr-axSpa patients using anti-TNF, related to the requirements of social insurance system. Disclosure of Interest None declared

AB0897 The relationship between disease-specific indices and balance in patients with ankylosing spondylitis

Background Axial and periferal joint stifness, impaired joint mobility and postural deformities may affect balance in AS. However factors affecting balance in AS patients are still unclear. There is limited literature investigating balance-related factors in patients with AS and the results are contradictory. Objectives The aim of the study was to investigate relationship between disease-specific indices and balance in patients with AS. Methods 72 patients(46 male, 26 female) with AS were included in the study. The demographic and anthropometric features(age, weight, height, body mass ındex(BMI)) of patients were recorded. Disease-specific indices used in the study were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Mobility Index (BASMI). BASDAI for disease activity, BASFI for functional capacity, BASMI for spinal mobility were used. Static and dynamic balance was evaluated with Biodex Balance System SD. Limits of stability and bilateral stance (stable and unstable platform), single leg stance (stable platform) postural stability test results were recorded. Overall stability(OA) indices were used. A high score in the OA index indicates poor balance. Spearman correlation test used for statistical analysing. Correlation analyses were performed between BASDAI, BASFI, BASMI scores and Biodex test results Results The mean age of patients was 39,95±8,84 years and mean BMI was 26,55±3,82 kg/m2. BASDAI, BASFI and BASMI scores of patients are shown in table 1.Abstract AB0897 – Table 1 BASDAI, BASMI and BASFI scores AS patients(n=72)Median(IQR 25–75) BASDAI 2,10 (1,02–3,78) BASFI 1,10 (0,30–2,74) BASMI 2,20 (1,00–3,40) Only positive weak correlation was found between BASFI score and right leg stance overall postural stability index (r=0,25, p=0,034). No other correlation was detected between BASDAI, BASFI, BASMI scores and Biodex balance test results. Conclusions The results of our study indicated that there is no relationship between BASDAI, BASFI, BASMI scores and balance except BASFI score and right leg stance postural stability. Our results contradict some previous studies while supporting some studies. This may be due to in our study BASDAI, BASFI and BASMI scores are lower than previous studies or the usage of different methods from previous studies for evaluating balance and postural stability in AS. Further studies are required to establish the actual status of relationship between balance and clinic measurements in AS patients. Reference [1] Pompeu, J.E., Static and dynamic balance in subjects with ankylosing spondylitis: literature review. Revista brasileira de reumatologia, 2012. 52(3): p. 413–416. Disclosure of Interest None declared

THU0314 Radiologic activity is the major determinant for physicians while deciding active disease in takayasu arteritis

Background There are no valid follow-up parameters in the assessment of disease activity in Takayasu arteritis (TA). Objectives We investigated the impact of incorporation of vascular imaging into ITAS in the assessment of disease activity in TA. Methods 52 patients who fulfilled the ACR criteria were included in the study. PGA, Kerr et al.s criteria and ITAS2010/ITAS-A scores were evaluated in all patients in serial visits. All the patients were followed using 3–6 monthly B-mode/Doppler ultrasonography (USG) and 6–12 monthly magnetic resonance angiography (MRA). Radiological activity (Rad) was defined based on the presence of any of the 3 parameters including new vessel involvement by any technique (5 points),increase in vessel wall thickness on USG (3 points) and vessel wall edema on MRA (3 points).Then we incorporated these scores with ITAS-A to obtain a composite disease activity index (ITAS2010-A-Rad) (Table 1). Active disease was defined as ITAS-A-Rad >4 points. Results Total 410 visits of 52 TA patients (mean age 50.7 yrs, F: 92.3%, mean follow-up duration:6.4±2.9 yrs) were evaluated. Radiological assessment was done in 359 visits (by USG in 271 and by MRA in 190). Patients were categorized as having active disease in 194 visits (47.4%) according to PGA and 72 visits (17.5%) according to Kerr et al. criteria.The agreement between them was fair (66%, κ: 0.29). Radiological activity was determined in 105 out of 359 visits (29.2%). The total agreement between radiological activity and Kerr at al. criteria was 83% (κ: 0.58). It was found to be 76% (κ: 0.52) between radiological activity and PGA. Mean ITAS-A-Rad scores were found to be significantly higher in visits with active disease compared to visits with inactive disease according to both PGA and Kerr et al. criteria (Table 2). The ITAS-A-Rad was significantly correlated with all the other activity parameters including ITAS2010, ITAS-A, and APRs. There were 43 visits with new vessel involvement by any radiologic technique; all visits included patients with active disease based on both PGA and Kerr et al. criteria. Whereas in 50% of these visits, patients had normal CRP, and %49 had normal ESR. The agreement between ITAS2010 and PGA was fair (69%, κ: 0.38).When APR was added (ITAS-A), it did not improve (68%, κ: 0.34). But the agreement between ITAS-A-Rad and PGA (72%, κ: 0.50) and also Kerr et al. criteria (82%, κ: 0.56)was found to be moderate. Interestingly, when only USG (ITAS-A-USG) or only MRA (ITAS-A-MRA) was used, the agreement with PGA was remained unchanged (73%, κ: 0.45 and 76%, κ: 0.52, respectively). When responsiveness to change of ITAS-A-Rad score was evaluated by serial visits of patients, it was found that the mean value of the score was discriminative for activity according to PGA in 9 of 11 visits (Figure 1).Table 1. The definition of ITAS-A-Rad Score Clinical ITAS2010 0– Laboratory APR ESR 0 for ESR<20 1 for 21–39 2 for 40–59 3 for >60 mm/h 0–3 CRP 0 for CRP≤5 1 for 6–10 2 for 11–20 3 for >20mg/l Radiology Radiological activity New vessel involvement with any radiological method 5 B-mode Doppler USG Progression on vessel wall thickness 3 MRA Presence of vessel wall edema 3 Total ITAS-A-RAD Score ITAS-A-Rad Score >4 –> Activity. Conclusions The results of this study suggest that ITAS-A-Rad may be used to be a valuable foIlow-up parameter in the assessment of disease activity. Disclosure of Interest None declared

AB0597 Adaptation of Ucla Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 Questionnaire into Turkish

Background Nearly 90% of patients with scleroderma (SSc) have gastrointestinal tract (GIT) involvement in variable severities and is a challenging process for clinicians. The University of California Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0 (UCLA SCTC GIT 2.0) is a questionnaire including 34 items, 7 multi-item scales: reflux, distention/bloating, diarrhea, fecal soilage, constipation, emotional well-being and social functioning. By these parameters, a total GIT score is calculated (1). This scale translated in German, Italian, French, Polish, Spanish, Swedish, Dutch before, they are available in http://www.uclascleroderma.researchcore.org/website (1–3). There is no Turkish version of this scale yet. Objectives Our aim is to make translation, cultural adaptation of the UCLA SCTC GIT 2.0 into Turkish, and assess reliability of the scale in patients speaking Turkish. Methods UCLA SCTC GIT 2.0 scale was translated into Turkish according to international guidelines and applied to 97 SSc patients. The questionnaire repeated in 29 patients after an interval of 15 days for determining reliability. For internal consistency, Cronbachs alpha was calculated, reliability coefficient if item deleted and test-retest reliability also determined. External consistency was measured by comparing with the Short Form (SF)-36 by Spearmans correlation analysis (rho: ≤0.29 weak, 0.30–0.49 middle, ≥0.50 strong). Results 97 scleroderma patients were included in this study (female:87.6%, mean age:55.4±11.4). Internal consistency Cronbachs alpha was calculated as 0.89, reliability coefficient if item deleted was 0.89–0.90. External consistency of UCLA SCTC GIT 2.0 was measured by comparing with the SF-36, correlation was meaningful in medium level (Table 1,2).Table 1. Descriptive statistics and internal consistency statistics UCLA SCTC GIT 2.0 Scale n Mean score (SD) Minimum score Maximum score Cronbach alpha Floor effect % Ceiling effect % Reflux 97 0.64 (0.54) 0.0 2.6 0.83 17.5 0.0 Distension 97 1.02 (0.75) 0.0 3.0 0.58 7.2 1.0 Soilage 97 0.30 (0.72) 0.0 3.0 0.68 82.5 3.1 Diarrhea 97 0.28 (0.47) 0.0 1.5 0.36 69.1 0.0 Social Functioning 97 0.17 (0.32) 0.0 1.3 0.47 67.0 0.0 Emotional Wellbeing 97 0.30 (0.43) 0.0 2.2 0.73 41.2 0.0 Constipation 97 0.63 (0.69) 0.0 2.5 0.56 34.0 0.0 Total GIT score 97 0.45 (0.37) 0.0 1.6 0.82 3.1 0.0 All scales are scored from 0.00 (better HRQOL) to 3.00 (worse HRQOL) except the diarrhea and constipation (range from 0.00–2.00 and 0.00–2.50, respectively). The UCLA GIT 2.0 provides a total score of GIT severity and calculated by summation of all scales (except constipation) and ranges from 0.00 to 2.83. Conclusions UCLA SCTC GIT 2.0 scale had strong internal consistency, good reliability and acceptable validity when adapted into Turkish. Turkish-speaking patients with scleroderma, this scale will be useful to assess GIT symptoms. The basic constraint of our study was, not using image procedures for objective GIT involvement evidences. References Khanna D,Reliability and validity of the UCLA SCTC GIT Instrument.Arthritis Rheum,2009. Bae S,Development and validation of French version of the UCLA SCTC GIT Instrument.Clin Exp Rheumatol, 2011. Meijs J,Translation,cross-cultural adaptation,and validation of the UCLA SCTC GIT 2.0 into Dutch. Clin Exp Rheumatol,2014. Disclosure of Interest None declared

AB1120 Comparison of Long-Term Drug Survival of Tumor Necrosis Factor Inhibitors in Patients with Rheumatoid Arthritis, Ankylosing Spondylitis and Psoriatic Arthritis: A Single Center Turkish Experience Over a Decade

Background The studies from different national biologics registries provide data on long term efficacy and safety of tumor necrosis factor inhibitors inhibitors (TNFi) for the treatment of rheumatic diseases in diverse patient populations. The data in this regard is lacking in Turkish population. Objectives To assess and compare the long term drug survival rates of TNFi in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic Arthritis (PsA) and to identify potential reasons for treatment discontinuation. Methods The analysis included all the patients treated with TNFi at our center since 2004. Persistence on anti-TNF in patients who were lost to follow-up were analyzed using the national prescription database. Patients with no prescription over the last 6 months were considered to have discontinued the treatment. The date of the last prescription was accepted as the date of discontinuation. These patients were tried to be contacted by phone to identify the reason for discontinuation. Kaplan-Meier plots and log rank tests were used to assess drug survival. Results Of the 351 patients in the study 222 had AS (26.1% females, mean age: 44.3±11.7 years, mean disease duration: 20±9.9 years, HLA-B27:(+): 71.1%), 96 had RA (78.2% females, mean age: 53±13.9 years, mean disease duration: 15.1±7.7 years, RF (+): 59.1%, anti-CCP (+): 67.9%) and 32 had PsA (62.2% females, mean age: 47±14.2, mean disease duration: 12.2±8.7). Etanercept (ETA) was started in 123 (35.1%) patients, infliximab in 116 (33.1%), adalimumab (ADA) in 98 (28%) and golimumab (GOL) in 13 (%3,7). Over an observational period of up to 10 years, biologic treatment was discontinued in 198 (56.4%) patients, of whom 137 (69%) were switched to another TNFi. Drug survival rate for all of the three anti-TNF-α agents is 48.6% for AS, 37.5% for RA, and 40.6% for PsA. Median drug survival time in AS was 67.4 (95% CI, 58.5-76.3) and seemed to be longer than in RA (51.6 months, 95%CI 37.8-65.4) and PsA (45.5 months, 95% CI 30.0-61.0). No difference was observed between different TNFi within the same disease category. In patients with RA, female patiens had a longer drug survival than male patients. The reasons for discontinuation were inefficacy in 86 patients (44.3%), adverse events in 45 (23.2%) (tuberculosis in 2 patients, malignancy in 4 patients), remission in 10 (5.2%) and other or unclear reasons in 55 (29.3%). During the observational period four patients died, one due to lymphoma which developed during anti-TNF therapy, one due to metastatic germ cell tumor which developed one year after the cessation of antiTNF therapy, two due to possibly not related to the anti-TNF therapy. Conclusions Our single center study indicate generally similar long term drug survival rates for TNFi within a disease category. The trend for a better long term drug survival in this study is in line with some previously published. Disclosure of Interest G. Can: None declared, S. Capar: None declared, P. Cetin: None declared, D. Solmaz: None declared, G. Kenar: None declared, H. Yarkan: None declared, S. Akar: None declared, M. Birlik: None declared, I. Sari: None declared, F. Onen: None declared, N. Akkoc Grant/research support from: Pfizer UCB, Consultant for: Pfizer UCB Abbvie MSD BMS, Speakers bureau: Pfizer UCB Abbvie MSD