L. Akyol

The Psoriatic Arthritis Registry of Turkey: results of a multicentre registry on 1081 patients.

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.

Bilateral sacroiliitis and uveitis comorbidity: brucellosis? Ankylosing spondylitis?

We present a rare case of a comorbidity of sacroiliitis and brucellosis infection. A 28-year-old woman received irregular medication due to ongoing backache and hip pain for 5 years. The patient presented to our hospital for evaluation of visual loss and was diagnosed with uveitis. Sacroiliac MRI was performed to investigate the inflammatory backache and hip pain, and the aetiology of the uveitis, revealing the presence of sacroiliitis. The patients blood test results were as follows: positive brucellosis Rose Bengal test and positive tube agglutination test with a titre of 1/640. The patient was treated with doxycycline and rifampicin for 8 weeks for the brucellosis infection, and with acemetacin for the ankylosing spondylitis. The patients back and hip pain decreased significantly 8 weeks later; however, the uveitis was not controlled by the treatment. Therefore, anti-tumour necrosis factor (infliximab) treatment was started.

Axial psoriatic arthritis: the impact of underdiagnosed disease on outcomes in real life

Psoriatic arthritis (PsA) may affect different joints, including the spine. The prevalence of spinal involvement is variable depending on the definition and a subset of patients have been identified in cohorts that do not have clinical features of axial disease and yet have imaging findings. Still, there is not a consensus on how and when to screen axial disease. In this study, we aimed to investigate factors associated with being underdiagnosed for axial psoriatic arthritis (axPsA) and its impacts on outcomes. Disease features and outcomes of axPsA according to the physician (n = 415) were compared with patients with imaging findings only (sacroiliitis fulfilling the modified New York criteria, n = 112), using data from a real-life PsA registry. Patients with imaging findings only were more frequently women (83/220 (37.7%) vs 29/122 (23.8%); p = 0.008). This group also had higher peripheral disease activity (imaging only vs clinical AxPsA: mean (SD) tender joint count 5.3 (6.1) vs 3.3 (4.7), swollen joint count 1.9 (2.9) vs 1.2 (2.4); p < 0.001 for both comparisons) and was less often treated using TNF inhibitors (16.1 vs 38.2%; p < 0.001) than patients who were classified as axPsA. Patient-reported outcomes were similar in both groups. PsA patients, especially women with more severe peripheral disease, have a higher risk of being underdiagnosed for axPsA. The severity of peripheral symptoms may be a risk factor to mask the spinal features of PsA.

Ptosis and Mass Like Lesions in Behçet’s Disease: A Rare Presentation

In this article, we describe a case of neuro-Behçets disease presenting with unilateral ptosis and facial paresis due to an intracranial mass lesion. A 25-year-old male patient with a history of Behçets disease presented with headache, vertigo, double vision, ptosis in his right eyelid and slurred speech. Cranial magnetic resonance imaging scan revealed a right-sided capsulothalamic lesion, which was extending to the right cerebral pedicle, pons and superior cerebellar pedicle. This lesion was interpreted as neuro-Behçets disease involvement of central nervous system. Cerebral mass- like lesion is a rare form of neuro-Behçets disease. Review of the literature revealed a limited number of cases. Ptosis related with Behçets disease is also a very rare presentation. This case shows that this symptom might be a part of the clinical presentation of neuro-Behçets disease.

Heterotopic ossification (myositis ossificans progressiva): A condition interfering with rheumatic disease

A 47-year-old woman presented with an approximately 1.5-year history of swelling and pain in the hand, elbow, shoulder, knee, and temporomandibular joint; bruising (either spontaneously or following a trauma); and pruritus all over the body. She was diagnosed with rheumatoid arthritis (RA) and was prescribed immunosuppressive drugs. Although the patient regularly took these medications, her joint pain and limited movement increased daily over the course of 1.5 years. Physical examination revealed limited motion, swelling, and tenderness in her wrists, metacarpophalangeal joints, proximal interphalangeal joints, elbows, shoulders, and knees. The patient had subcutaneous nodular lesions and itching on her arms, back, and both hips and ecchymoses on her legs. Her laboratory test results were as follows: hemoglobin, 11.2 (12–15) g/dL; calcium, 10.5 (8.6–10.0) mg/dL; gamma-glutamyl transferase, 126 (5–36) U/L; alkaline phosphatase, 106 (35–104) U/L; erythrocyte sedimentation rate, 18 (0–20) mm/h; and C-reactive protein, <3.3 (0.0–3.5) mg/L, and rheumatoid factor, anticyclic citrullinated peptide antibodies, and anti-nuclear antibodies were negative. There were no erosive changes in her hand joints that were suggestive of RA. Knee magnetic resonance imaging (MRI) was performed because of pain, swelling, and flexion contracture in the knee joint; the findings are shown in Figure 1. Full-body scan and regional single-photon emission computed tomography (SPECT)/CT revealed heterogeneous and symmetrical involvement of bony substance in the soft tissue around both hip joints, in the gluteal region, and around both shoulder joints; increased osteoblastic activity that was compatible with degenerative/inflammatory changes in both knee joints, elbows, and ankle joints; involvement of bony substance in the soft tissue around the hip joint and medial border of both the lower and middle sections of the scapula; and concentration of symmetrical involvement of bony substance in the above-described areas that were compatible with heterotopic ossification (Figure 2). On the basis of clinical, radiographic, and SPECT/CT findings, the patient was determined to have heterotopic ossification.

THU0329 Budd-chiari syndrome in behÇet's disease: a retrospective multicenter study

Background The aim of this study was to determine the demographic, clinical, laboratory and management characteristics along with the clinical course of Budd-Chiari syndrome (BCS) associated with Behçets disease (BD). Methods Sixty patients with BD with BCS (40 male, 20 female) were identified in 23 rheumatology centers (Group I). A total of 169 consecutive patients (100 male, 69 female) with BD who did not have clinically apparent BCS during the follow-up were evaluated as the control group (Group II). Results Comparison of the demographic and clinical findings between the Group I and the Group II were as follows: The mean age of disease onset was 23.1 +/- 6.7 years vs. 26.8±0.6 years (p=0.013), mean age at diagnosis was 27.2±0.9 vs. 30.4±0.6 years (p=0.008), arthritis was 10% vs. 28.4% (p=0.002), papulopustular skin lesion was 48.3% vs 69.2% (p=0.003), central nervous system (CNS) involvement 10% vs. 3% (p=0.03), cardiac involvement was 16.7% vs. 2.4% (p<0.001), superficial thrombophlebitis was 23.3% vs. 4.7% (p<0.001), and deep vein thrombosis was 58.3% vs. 15.4% (p<0.01). On diagnosis 50% of BD patients with BCS were classified as Child-Pugh A. Inferior vena cava obstruction was observed in 38.3% and portal vein thrombosis was seen in 3.3% of the patients with BCS. Mortality in BCS patients with BD was 18.3%. BCS related treatment after diagnosis in patients with BD were as follows: 71.7% of patients were treated with monthly cyclophosphamide intravenous pulses, 53.3% received intravenous pulse corticosteroids, 55.9% used azathioprine, 54.2% had warfarine treatment, and 50.8% were treated with low molecular weight heparin. Conclusions This study shows a higher frequency of cardiac and CNS involvement, superficial thrombophlebitis, papulopustular skin lesion, deep vein thrombosis in BD patients with BCS. Arthritis was observed less common in BD patients with BCS. The mean age onset was lower in patients with BCS. Medical treatment with immunosuppressive agents and anticoagulation appears to be the treatment of choice in BD patients with BCS. The majority of the patients with BCS were Child–Pugh class A on diagnosis. The inferior vena cava is frequently involved and, often associated with deep vein thrombosis and cardiac involvement. Disclosure of Interest None declared

A rare comorbidity: neurosarcoidosis and cutaneous sarcoidosis.

We present a case of a neurosarcoidosis patient with skin lesions. A 50-year-old woman was admitted with a 1-year history of violaceous, smooth and shiny plaques on her face and right arm. These lesions were biopsied and the histological examination indicated sarcoidosis. The patient had a history of headache and syncope that lasted for about 1 h. Brain CT showed masses measuring 37×20 mm in both frontal lobes. Thoracic and abdominal CT showed many pathologically enlarged lymph nodes. The patient was diagnosed with cutaneous, lung and neuronal sarcoidosis, and treated with 20 mg/day methylprednisolone, 15 mg/week methotrexate, 10 mg/week folic acid, 400 mg/day hydroxychloroquine and 800 mg/day carbamazepine. One month later, the patients neurological symptoms had improved and her skin lesions had decreased. At 6-month follow-up, the size of the cranial masses had markedly regressed.

SAT0582 Psoriasis Symptom Inventory is a Valid Patient-Reported Instrument for the Assessment of Skin Severityin Psoriatic Arthritis

Background Skin involvement in psoriatic arthritis (PsA) has significant impacts on health-related quality of lives in addition to the joint involvement. Due to this impact, its important to assess the severity of psoriasis to fully capture disease activity in PsA. In this study we aimed to test the validity of “Psoriasis symptom inventory” (PSI) in a cohort of patients with PsA. Methods PsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre, nationwide study in Turkey on patients with PsA. Patients are consecutively recruited to this registry, if they are diagnosed as PsA, regardless of any other disease characteristics. In this registry, PSI data was available in 237 patients. For the PSI the following items were scored on a scale between 0-4, by the patient: itching, redness, scaling, burning, stinging, cracking,flaking and pain. The PSI score was calculated as a sum of these items and ranged between 0-32. The correlations between PSI and other outcome measures were investigated. Results The mean (SD) age and BMI were 44.7 (12.3) and 28.7 (5.6), respectively. Sixty-six percent of the patients were female. The duration of psoriasis in this group was 167.3 (124.2) months. Mean (SD) PSI scores were 6.7 (6.7) with a range of 0-32. PSI scores were found to be significantly correlated to patient (R=0.338) and physician global assessments (R:0.342), fatique (R=0.226), pain (R=0.334) (p<0.001 for all comparisons) and HAQ (R=0.198; p=0.007). PSI was also correlated to body surface area involved, measured by the physician (R=0.256, p=0.07). Conclusions PSI has a good construct validity in comparison to other clinical assessment tools. Due to its high feasibility, PSI can be a useful tool to investigate and record the severity of psoriasis in PsA in clinical practice. Disclosure of Interest None declared

AB0829 Demographics of Patients with New-Onset Psoriatic Arthritis: Real Life Data from an Inception Cohort: Table 1.

Background Psoriatic arthritis is a complex disease with a wide range of manifestations. In this inception cohort of PsA patients we aimed to identify the initial manifestations as well as disease activity characteristics and compare with an unselected group of patients with longstanding disease. Methods PsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre study in Turkey on patients with PsA. Patients are consecutively recruited to this registry. Patients who have been newly diagnosed with PsA have been identified, and their characteristics were compared with longstanding disease. Results Within 746 patients recruited, 111 (14.9%) had a new diagnosis for PsA. Patients in the inception cohort were significantly younger than the rest of the cohort (p=0.03) (table). Females were 53.2% of the inception and 66.8% of the non-inception cohort (p=0.007). For types of joint patterns, 14.4% of the inception cohort had only axial involvement whereas this was seen in 8.2% for the other group (p=0.05). The other joint patterns were comparable among groups. Both groups had similar tender and swollen joint counts, BASDAI and BASFI. Patient (p=0.002) and physician global assessments (p<0.001), fatigue (p=0.02), duration of morning stiffness (p=0.02) and CRP (p=0.05) were higher in the inception cohort. Female patients had higher patient global assessment and fatigue scores despite similar physician global assessment, swollen and tender joint counts, BASDAI, BASFI and CRP with males in non-inception cohort. For the inception cohort, there were no differences between the 2 genders.Table 1. Disease characteristics of the groups Inception cohort Non-inception cohort Whole group Females Males Whole group Females Males n 111 59 52 635 424 211 age 42.5 (12.3) 44.4 (12.5) 40.4 (11.7) 45.5 (12.9) 46.7 (13) 43.1 (12.4) SJC 2.7 (3.4) 2.5 (3.2) 3 (3.6) 1.6 (2.8) 1.5 (2.8) 1.6 (2.7) TJC 4.1 (4) 3.8 (3.7) 4.5 (4.2) 3.4 (4.7) 3.5 (4.8) 3.4 (4.2) BASDAI* 4.5 (2.4) 4.3 (2.2) 4.8 (2.5) 3.7 (3.8) 3.8 (4.3) 3.5 (2.6) BASFI* 3.2 (2.4) 3 (2.3) 3.4 (2.4) 2.8 (2.7) 2.7 (2.7) 2.8 (2.7) Patient global* 4.9 (2.5) 4.7 (2.3) 5.1 (2.6) 3.9 (2.3) 4 (2.3) 3.5 (2.4) Physician global* 4.2 (1.9) 4 (1.6) 4.4 (2.1) 3.1 (2.1) 3.1 (2) 3 (2.2) fatigue* 4.9 (2.5) 5 (2.3) 4.9 (2.7) 4.2 (2.6) 4.5 (2.5) 3.7 (2.8) CRP (mg/lt) 13. 4 (23.4) 9.5 (16.5) 18 (29.1) 8.7 (16.2) 8.6 (16.1) 9 (16.5)* Data given on a scale between 0–10. There were missing data. The number of cases with available information are: BASDAI: 434, BASFI: 413; patient global assessment: 493; physician global assessment 440, fatigue: 506, CRP: 717, tender joint count: 677, swollen joint count: 672. Conclusions More patients present with sole axial involvement at the beginning, which may explain the higher disease activity agreed by the patient and the physician despite similar tender and swollen joint counts. Females may have a different perception of the disease with worse patient global assessments and fatigue in longstanding disease. Disclosure of Interest None declared

AB0036 Comparison of Tuberculin Skin Test and T-Spot.TB Test in Patients with Receiving Corticosteroid or Immunosuppressive Treatments

Background Cytotoxic or anti-TNF therapies increase risk of reactivation of latent tuberculosis infection (LTBI). Therefore screening for latent tuberculosis is mandatory before initiating therapy. On the other hand, these patients who are candidate for cytotoxic or anti-TNF therapies are already on corticosteroid or immunosuppressive treatments. These treatments give rise to false-negative tuberculin skin test (TST) results. It has been reported that interferon-gamma release assays tests have a higher sensitivity on receiving corticosteroid or immunosuppressive treatments. Objectives This study aimed to comparison of tuberculin skin test and T-SPOT.TB test in patients with receiving corticosteroid or immunosuppressive treatments. Methods 38 patients were documented before introducing cytotoxic or anti-TNF therapies between November 2012 and November 2014. Results of T-SPOT.TB test and TST and current medication were enrolled. TST values > or =5 mm was accepted as TST positivity. According to use of corticosteroid the patients were divided into two groups. The patients receiving 20 mg methylprednisolon for three days before TST were included in Group I. The remaining patients were included in Group II. Results In Group II TST were anergy in 6/14, negative in 1/14, positive in 7/14 patients. In Group I TST were anergy in 21/24, positive in 3/24 patients. When compared with Group II the numbers of anergic patient was higher while result of positive TST was lower in Group I (both for p<0.001). The T-SPOT.TB test results were similar between both groups. 7 patients with methotrexate and 2 patients with azathioprine were being treated. In this study, there were no effects of methotrexate or azathioprine on TST or T-SPOT.TB test. Conclusions This study demonstrated that TST is evidently affected by corticosteroid treatment in a dose- and time-dependent manner. Therefore, it seems that T-SPOT.TB test is more appropriate for LTBI diagnosis in patients with treated corticosteroid. Disclosure of Interest None declared