Kevser Gök

The Turkish Version of Multidimensional Assessment of Fatigue and Fatigue Severity Scale is Reproducible and Correlated With Other Outcome Measures in Patients With Systemic Sclerosis

Objectives This study aims to evaluate the reproducibility of Turkish versions of multidimensional assessment of fatigue (MAF) and fatigue severity scales (FSS) and the relationship between health related quality of life, disability, and psychological status in patients with systemic sclerosis (SSc). Patients and methods A total of 21 female patients (mean age 47.14±10.39 years; range 18 to 75 years) who met 2013 American College of Rheumatology/European League Against Rheumatism criteria for SSc were evaluated for severity of organ involvement and symptoms. Turkish version of MAF, FSS, and visual analog scale of fatigue were assessed at baseline and after two to three weeks. Level of dyspnea was noted and disability, functional limitation, and quality of life were assessed by health assessment questionnaire, 6-minute walking distance, and short-form 36, respectively. Results Ten patients had diffuse and 11 had limited SSc. MAF subscales and FSS had significant correlations with short-form 36-vitality subscale and 6-minute walking distance. Intraclass correlation coefficients for FSS and visual analog scale of fatigue were 0.824 (95% confidence interval, 0.566- 0.929) and 0.932 (95% confidence interval, 0.832-0.972), respectively. The intraclass correlation coefficients for MAF subscales changed between 0.916 and 0.968, except for MAF-timing (intraclass correlation coefficient, 0.404). Conclusion Our results revealed that FSS and MAF subscales had high reproducibility and correlated well with quality of life and disability scales which, to some extent, may suggest convergent validity of MAF subscales and FSS in SSc. The incompatible nature and four-choice answering in two items of MAF-timing may be the underlying reason for trivial relationship with other parameters. The Turkish version of MAF and FSS may be used to assess fatigue in patients with SSc.

Relationship between cytosine-adenine repeat polymorphism of ADAMTS9 gene and clinical and radiologic severity of knee osteoarthritis

The aim of this study is to determine the role of cytosine‐adenine (CA) micro‐satellite repeat sequence of ADAMTS9 gene on the development and progression of osteoarthritis (OA).

Comparison of Pain Characteristics in Patients with Rheumatoid Arthritis and Systemic Sclerosis with Particular Reference to Neuropathic Pain Component: Cross-Sectional Study

Objective: The aim of the study was to compare characteristics of pain in terms of neuropathic pain (NeP) and to assess the association between the neuropathic component and quality of life (QoL) in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Subjects and Methods: Fifty-four patients (47 females, 7 males) with SSc and 53 patients (46 females, 7 males) with RA were assessed for outcome measures including disease activity, physical functions, mental condition and health-related QoL (HRQoL) measures (Short Form-36; Hospital Anxiety and Depression Scale), and pain. NeP was assessed by the Douleur Neuropathique 4 (DN4) and PainDetect questionnaires in this cross-sectional study. Results: The patients had similar education, smoking status, functioning, and HRQoL. However, the patients with RA declared a more severe visual analogue scale of pain and a higher BMI than those with SSc. The NeP component was detected in 42.6% (n = 23) of the SSc patients and in 45.3% (n = 24) of the RA patients (p > 0.05) according to DN4. On PainDetect, possible NeP was detected in 13.0% (n = 7) versus 15.1% (n = 8), whereas 16.7% (n = 9) versus 17.0% (n = 9) were likely to have NeP in SSc and RA, respectively (p > 0.05). Most of the NeP characteristics were similar in SSc and RA, except for numbness and painful cold, which were notably more common in patients with SSc. Having the NeP component (according to DN4) had no influence on functioning and HRQoL in SSc; however, the NeP component revealed a heavier burden of disease regarding functional status, HRQoL, and psychometric components in RA. Conclusion: The NeP component was similar between patients with SSc and RA. However, NeP was associated with a heavier burden of disease in patients with RA.

Comparison of Level of Fatigue and Disease Correlates in Patients With Rheumatoid Arthritis and Systemic Sclerosis

Objectives This study aims to compare the levels of fatigue in patients with rheumatoid arthritis (RA) and systemic sclerosis (SSc) and to assess the potential influence of fatigue on clinical variables. Patients and methods Age- and sex-matched adult patients with SSc (n=50; 6 males, 44 females; mean age 47.7 years; range 23 to 72 years) and RA (n=51; 6 males, 45 females; mean age 50.8 years; range 23 to 71 years) were consecutively recruited. Patients were examined and evaluated for disease specific and generic outcome measures including disease activity parameters, physical functions, psychological status, and health related quality of life measures. Level of fatigue was assessed by Fatigue Severity Scale and Multidimensional Assessment of Fatigue scale. These were interviewed by the same experienced physician who was blind to clinical data. Results Patients had similar educational and smoking status, as well as functioning and health related quality of life. However, patients with RA declared higher levels on visual analog scale-pain (p=0.012) and higher body mass index than patients with SSc (p<0.0001) and lower distances in six-minute walking test (p=0.002). Levels of fatigue were quite similar between patients with RA and SSc. Levels of fatigue, measured by different scales, were significantly correlated with physical functions and health related quality of life measures and psychometric variables in both groups; however, the correlation coefficients were relatively higher in patients with RA. Conclusion Fatigue is a major problem in patients with RA and SSc. Our findings revealed that level of fatigue was quite similar between patients with RA and SSc and significantly correlated with physical functions and health related quality of life. Patients with RA and SSc should be carefully evaluated for fatigue by using valid scales and the impact of fatigue on clinical measures should not be overlooked.

SAT0245 Comparison of Pain Characteristics in Patients with Rheumatoid Arthritis and Systemic Sclerosis: A Cross-Sectional Study

Background Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by progressive destruction of inflamed joints leading to severe disability and functional loss. Systemic sclerosis is a multisystem autoimmune disease characterized by vasculopathy, diffuse fibrosis of skin and various internal organs. Pain is usually an overlooked entity in patients with SSc compared to RA. Objectives To compare pain characteristics particularly in terms of neuropathic pain (NeP) and to assess the possible impact of neuropathic component on functioning, physical and mental components of health related quality of life (HRQoL) in patients with RA and SSc. Methods Patients who met ACR/EULAR criteria for SSc and RA were recruited. Patients with prior diagnosis or taking medications for NeP, mood disorders, uncontrolled diabetes or neurological disorders or taking any biologic agents for their treatments were excluded. Patients were examined and evaluated for disease specific and generic outcome measures including disease activity parameters, physical functions, psychological status and health related quality of life measures (SF-36; HAQ; Hospital Anxiety and Depresson Scale, HADS). The DN4 interview and PainDetect questionnaire were applied by the same experienced physician who was blind to patients clinical and outcome data. Patients with a score ≥4 in DN4 were considered as “probable NeP”; between 13–18 or ≥19 in PainDetect were considered as “possible” or “likely NeP”, respectively. Results Fifty patients (44 F, 6 M) with SSc and fifty-one (45 F, 6 M) with RA were included. Patients had similar age and similar gender, educational and smoking status, as well as functioning and HRQoL. However, patients with RA declared more severe pain on VAS-pain (p=0.012), and higher body mass index than patients with SSc (p<0.0001). NeP component was similar in patients with SSc vs RA. NeP component was detected 42.0% in SSc, and 47.1% in RA (p>0.05) according to DN4 scores. According to PainDetect questionnaire, possible NeP was detected in 12.0% vs 15.7%, whereas 16.0% vs 17.6% had likely NeP in SSc and RA, respectively (p>0.05). Neuropathic characteristics of pain were similar in SSc and RA defined as burning, electric shock, tingling, pins and needles, and itching except for numbness and painful cold which were significantly more prevalent in patients with SSc (%50.0 vs %25.5, p=0.011 and %50.0 vs %19.6, p=0.001; respectively). In SSc patients with or without NeP component had similar functioning and HRQoL measures. However, having NeP component revealed a heavier burden of disease regarding functioning, HRQoL and psychometric components patients with RA. NeP +ve NeP −ve P SSc (n=21) (n=29)  Age 53.43±9.58 43.55±13.82 0.004  HAQ 0.55±0.62 0.53±0.60 0.758  SF-36 – PCS 53.90±21.62 48.58±20.41 0.350  SF-36 – MCS 64.33±21.36 53.87±20.85 0.087  HADS – depression 7.76±3.45 7.10±3.63 0.636  HADS – anxiety 7.38±3.75 6.10±4.17 0.252  6-min walk, m 408.95±67.16 433.21±82.46 0.336 RA (n=24) (n=27)  Age 50.21±9.17 51.30±11.02 0.850  HAQ 0.48±0.62 0.57±0.64 0.727  SF-36 – PCS 40.55±17.63 59.77±20.37 0.0001  SF-36 – MCS 42.83±15.06 68.99±21.14 0.0001  HAD – depression 9.29±4.30 5.56±4.33 0.004  HAD – anxiety 10.08±3.78 5.67±4.37 0.0001  6-min walk, m 378.33±77.27 368.15±69.74 0.690 Conclusions The NeP component was similar in patients with RA and SSc. However NeP was associated a heavier burden of disease in patients with RA. Disclosure of Interest None declared

SAT0246 Comparison of Level of Fatigue and Disease Correlates in Patients with Rheumatoid Arthritis and Systemic Sclerosis

Background Rheumatoid arthritis (RA) and systemic sclerosis (SScl) are two different forms of connective tissue diseases associated with significant morbidity. While fatigue is not required for a diagnosis of RA or SScl persistent fatigue is an important clinical problem which may interfere with loss of functioning and health related quality of life (HRQoL) and contribute to the increased disease burden. Several studies compared these two diseases in terms of clinical, laboratory and imaging aspects, however level of fatigue has not been evaluated comparatively. Objectives The aim of this study was to compare levels of fatigue in RA and SSc and to assess potential influence of fatigue on clinical variables. Methods Patients meeting the ACR/EULAR criteria for SSc and RA with an age more than 18 were consecutively recruited. Patients with a prior diagnosis of psychiatric disorders or fibromyalgia or taking medications for these disorders, or with uncontrolled diabetes, neurological disorders or taking any kind of biologic agents were excluded. Patients were examined and evaluated for disease specific and generic outcome measures including disease activity parameters, physical functions, psychological status and health related quality of life (HRQoL) measures. Level of fatigue was assessed by Fatigue Severity Scale (FSS) and Multidimensional Assessment of Fatigue (MAF) scale. These were interviewed by the same experienced physician who was blind to clinical data. Results Fifty patients (44 F, 6 M) with SSc and fifty-one (45 F, 6 M) with RA were included. Patients had similar age and similar gender, educational and smoking status, as well as functioning and HRQoL. However, patients with RA declared higher levels on VAS-pain (p=0.012), and higher body mass index than patients with SSc (p<0.0001) and lower distances in 6-minute walking test (p=0.002). Levels of fatigue which were assessed by VAS, FSS and MAF were quite similar between patients with RA and SSc. Levels of fatigue, measured by different scales, were significantly correlated with physical functions and HRQoL measures and psychometric variables in both groups, however the correlation coefficients were relatively higher in patients with RA. SSc, n=50 RA, n=51 P Age 47.70±13.07 50.78±10.11 0.189 BMI, kg/m2 26.26±5.95 30.96±6.17 0.0001 Symptom duration, years 10.10±7.04 11.06±8.01 0.525 VAS – pain 3.95±2.94 5.25±2.08 0.012 HAQ 0.54±0.60 0.53±0.63 0.946 SF-36 – vitality 48.40±20.26 51.76±21.54 0.421 SF-36 – PCS 50.81±20.88 50.72±21.27 0.983 SF-36 – MCS 58.27±21.49 56.68±22.60 0.719 FSS 4.67±1.77 4.39±1.94 0.439 MAF – severity 6.37±2.07 5.50±2.37 0.064 MAF – distress 5.80±2.74 5.56±2.56 0.656 MAF – interference ADL 4.78±2.25 5.07±2.17 0.534 MAF – timing 6.39±2.05 6.56±2.08 0.696 MAF – global fatigue index 27.77±12.22 25.27±12.77 0.317 6-min walk, m 423.40±76.82 372.94±83.43 0.002 VAS – F 5.96±2.67 5.14±2.84 0.148 Conclusions Fatigue is a major problem in patients with RA and SSc. This is the first report comparing these two diseases in terms of fatigue and its correlates. Patients with RA and SSc should be carefully evaluated for fatigue by using valid scales and the impact of fatigue on clinical measures should not be overlooked. Disclosure of Interest None declared

AB0914 Management of Gout in Different Clinical Specialties in Turkey

Background In contrast to many European countries, patients can easily admit to secondary and tertiary centers without referral by the primary care in Turkey. Therefore we also compared the management options for gout preferred in different clinical specialties. Objectives In this study we investigated how gout is treated in Turkey. Methods 319 consecutive patients were included in this multicenter study (mean age 58.60±12.8 years, 44 females, 272 males). All patients filled a standard questionnaire. Results 53 patients were first admitted to primary care (16.6%), 101 patients to orthopedics (31.7%), 29 patients to physical therapy and rehabilitation (9.1%), 70 patients to internal medicine (21.9%), 49 patients to rheumatology departments (15.4%), and 17 patients to other clinical specialties (5.3%). Among those 313 patients admitting to health care with acute gout attack, 40 patients were referred the patient to another center without any treatment (12.8%). Referral rate remarkably higher in the primare care (%28.8). NSAIDs were the most common drugs prescribed for acute attack (60.06%), followed by colchicine (58.15). Allopurinol was given in 12.8%, and steroids in 7.99% of patients during acute attack. Regarding long term treatment, 92 patients had never been treated with allopurinol (28.8%). 29.1% (37/127) patients having less than 2 attacks per year and 28.6% (55/192) of patients having two or more attacks per year had never been treated with allopurinol (p>0.05). Only 89 patients (27.9%) were treated with allopurinol by their first physicians, and 138 patients (43.3%) were treated with allopurinol later in a different specialty. Prescription of allopurinol was more common among the rheumatologists. Diet and life style modifications were recommended in 118 of the patients (37%) by their first physicians. 171 patients (53.6%) were later recommended diet and life style modifications during their follow up in a different clinical specialty (total 289 patients, 90.6%). Diet and life style modifications were recommended more commonly in rheumatology (41 patients, 83.7%). 183 (57.4%) were treated with colchicine by their first physicians, and 114 patients (35.7%) were treated with colchicine by a physician of different specialty (total 297 patients, 93.1%). Significantly more patients were treated with colchicine than with allopurinol during long term management (p<0.001). Conclusions Treatment of gout appears suboptimal in primary care, and more than 25% of patients were referred without any treatment. Long term management also appears suboptimal in both primary care and among some specialists such as orthopedics. Only a minority of patients were recommended allopurinol and/or life style modifications by the doctors first diagnosed gout. Although long term treatment appears better among rheumatologist, still a considerable number of patients were not recommended uric acid lowering approaches in the rheumatology clinics. Disclosure of Interest None declared

THU0470 The Relationship between Cytosine-Adenine Repeat Polymorphism in the Promoter Region of Adamts 9 (A Distintegrinand Metalloproteinase with Thrombospondin Motif 9) Gene and Clinical and Radiologic Severity of Knee Osteoarthritis

Background The relationship between ADAMTS genes and osteoarthritis (OA) may be crucial since these genes and their products may be used as biomarkers for prognosis and treatment of OA. Objectives To determine the role of cytosine-adenine (CA) micro-satellite repeat sequence of ADAMTS9 gene on the development and progression of OA. Methods Inclusion criteria for participants were ages 40 to 75 years, primary knee OA based on ACR knee OA criteria. Exclusion criteria included inflammatory rheumatic diseases, intraarticular injections, previous knee surgery, neurological or neuromuscular diseases, malignancies and secondary forms of knee OA. Patients were stratified into 2 groups using the K-L stages, based on radiologic severity as follows: Group 1: Stages 0 (no findings of OA including controls), Stages 1, 2 (mild OA) and Group 2: Stages 3,4 (moderately severe and severe OA). Results A total of 110 participants were enrolled. No significant differences were detected between group 1 and 2 in respect to sex, occupation, physical activity, smoking status, family history, ESR and CRP. When the length of CA repeat in ADAMTS9 gene was compared between group 1 and 2, for the right knee AUC of ROC curve was statistically significant (p=0.021). For the right knee, the 20-CA repeats was found to be statistically significant for differentiating groups 1 and 2 (p=0.02). For CA repeat length of ≥20, sensitivity was 39%, specificity was 81.2%, positive predictive value was 55.2%, negative predictive value was 69.1%, and diagnostic accuracy was 65.4%. Among all the risk factors included, age was the most significant risk factor, followed by ≥20 CA repeat and BMI. When corrected for the other risk factors, every 10-year increase in age was found to result in 2.5 fold increase in the probability of progression of OA to stages 3 and 4 (p=0.003). CA repeat length of ≥20 showed a 6.1 fold increase in probability for having OA at stage 3 or 4 compared to those of CA repeat length of <20 (p=0.004). Every 5 kg/m2 increase in BMI caused a 2.2 fold increase in the probability of having OA at stages 3 or 4 (p=0.022). Figure 1. The sensitivity and specifity (ROC curve) based on the length of CA repeat in differentiating between group 1 (K-L stages 0, 1, 2) and group 2 (K-L stages 3, 4) of the right knee. Conclusions When all risk factors are considered, older age, CA repeat of ≥20, and higher BMI are risk factors for progression into stage 3 and 4 in OA. The CA repeat length of ≥20 has a 6 fold increase in probability for having radiologically severe OA. This suggests that, ADAMTS9 gene CA repeat polymorphism may be used to determine the prognosis for OA radiologic progression. This could be highlighted further in future studies by studying CA repeat polymorphism in ADAMTS9 gene in larger sample size. References Jones GC, Riley GP. ADAMTS proteinases: a multi-domain, multi-functional family with roles in extracellular matrix turnover and arthritis. Arthritis research & therapy. 2005;7(4):160-9. Nagase H, Kashiwagi M. Aggrecanases and cartilage matrix degradation. Arthritis Res Ther. 2003;5(2):94-103. Tang BL. ADAMTS: a novel family of extracellular matrix proteases. The international journal of biochemistry & cell biology. 2001;33(1):33-44. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2280