M. Can

The Role of Depression, Anxiety, Fatigue, and Fibromyalgia on the Evaluation of the Remission Status in Patients with Rheumatoid Arthritis

Objective. To investigate the effect of depression, anxiety, fatigue, and fibromyalgia (FM) on the remission status in patients with rheumatoid arthritis (RA), defined according to the 28-joint count Disease Activity Score (DAS28)-erythrocyte sedimentation rate (ESR) and the Boolean-based new American College of Rheumatology/European League Against Rheumatism remission criteria. Methods. The subjects were patients with RA who participated in a hospital-based observational cohort. Patients who met the DAS28-ESR remission criteria at their latest visit were invited to participate in our study. The patient groups fulfilling or not fulfilling the Boolean remission criteria were identified and compared with each other with regard to the presence of depression, anxiety, fatigue (0–50), and FM. The relationship between psychosocial factors and Simplified Disease Activity Index (SDAI) remission, which is the index-based definition of remission in RA, was also investigated. Results. A total of 87 out of 428 patients (20%) with RA met the DAS28-ESR remission criteria and 32 (37%) of these also met the Boolean remission criteria, while 55 (63%) did not. Forty patients were also in SDAI remission. In the Boolean remission group, 2 patients had depression and 2 had anxiety (p = 0.004). In the Boolean nonremission group, 19 patients had depression and 13 had anxiety (p = 0.04). Continuous scales of anxiety (3.34 ± 3.76 vs 5.83 ± 4.70, p = 0.012) and depression (2.18 ± 2.75 vs 4.63 ± 4.10, p = 0.001) were also lower in the Boolean remission group in comparison with the nonremission group. Though FM syndrome was detected in only 1 patient of the Boolean remission group and in 7 patients of the Boolean nonremission group (p = 0.249), patients’ polysymptomatic distress scores of FM in the Boolean remission group were significantly lower than those of the nonremission group (3.12 ± 3.25 vs 6.27 ± 5.19, p = 0.001). The mean fatigue scores were 9.5 ± 10.6 in the Boolean remission group and 16.8 ± 12.8 in the Boolean nonremission group (p = 0.006). In multivariate analysis, patient’s global assessment (PtGA) and depression were found as the independent discriminators of Boolean-based definition. Similar relationships were also observed between psychosocial factors and SDAI remission. Conclusion. In patients with RA who do not fulfill the Boolean remission criteria, to avoid overtreatment, assessment of anxiety, fatigue, FM, and especially depression must be considered if PtGA scores and disease activity variables are significantly different.

Two-year experience with mycophenolate mofetil in patients with scleroderma lung disease: a case series.

To assess the effect of mycophenolate mofetil (MMF) on pulmonary functions in patients with systemic sclerosis‐associated lung disease (SSc‐ILD) who experienced an inadequate response to first line cyclophosphamide (CYC) therapy. Twelve consecutive SSc‐ILD patients who received MMF due to inadequate response to CYC as a first line agent, were retrospectively reviewed. Over the course of 2 years, pulmonary function tests (PFT) and high‐resolution computed tomography (HRCT) scans were performed. Following initial baseline tests, PFTs were continued at a frequency of every 6 months and HRCT scans were performed every 12 months. After MMF treatment, values of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) improved in three (25%) and two (16.6%) patients, respectively. It is also noted that the evaluation of serial HCRT scans showed no change in 54.5% of patients. Our case series suggested that PFT and imaging scores seemed to be stabilized by MMF in SSc‐ILD patients who were inadequate responders to CYC.

Conventional DMARD therapy (methotrexate-sulphasalazine) may decrease the requirement of biologics in routine practice of ankylosing spondylitis patients: a real-life experience.

The effect of disease‐modifying antirheumatic drugs (DMARDs) in ankylosing spondylitis (AS) is still controversial. We aimed to evaluate the efficacy of sulphasalazine (SSZ) mono‐ or combination therapy with methotrexate (MTX) in AS patients naive to anti‐tumor necrosis factor alpha (TNFα) agents.

Activity and damage in granulomatosis with polyangiitis

To retrospectively analyze disease activity and damage‐associated factors in granulomatosis with polyangiitis (GPA) in Turkey.

Dysexecutive syndrome: a specific pattern of cognitive impairment in systemic sclerosis.

Background and Purpose:Systemic sclerosis (SSc) is a connective-tissue disorder characterized by microvascular damage and tissue fibrosis. Although overt nervous system involvement is unusual in SSc, imaging studies have shown cerebral hypoperfusion. We evaluated cognitive functions in patients with SSc who had no history of neurological involvement, to seek cognitive impairment caused by the suggested cerebral hypoperfusion. Methods:We performed a comprehensive neuropsychological test battery on 31 patients with SSc and on 2 groups of age-adjusted, sex-adjusted, and education-adjusted controls: 15 patients with rheumatoid arthritis and 20 healthy volunteers. Results:The patients with SSc scored significantly worse on most of the measures of executive function than the 2 control groups (P<0.05). However, both patient groups did worse than the healthy controls on measures of attention and memory (P<0.005). Conclusions:Our results suggest that patients with SSc have a specific pattern of cognitive impairment: the dysexecutive syndrome. Attentional and memory problems, however, may arise from other confounders such as disease duration and chronic medication use. SSc may be a rare cause of vascular cognitive impairment.

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.

Fatigue in patients with Behcet's syndrome: relationship with quality of life, depression, anxiety, disability and disease activity

Fatigue is a common symptom of chronic inflammatory diseases. The objective of this study was to investigate fatigue in patients with Behçets syndrome (BS) and to examine the relationship between fatigue and disease activity, quality of life, anxiety and depression.

Clinically silent Crohn’s disease in a patient with Takayasu’s Arteritis unresponsive to conventional therapies

Takayasu arteritis (TA) and Crohn’s disease (CD) are chronic inflammatory diseases with granulomatous nature. Here, we report a case of TA with a silent course of CD who was refractory to corticosteroid and immunosuppressive treatments and improved with adalimumab therapy.

FRI0225 Presence of fibromyalgia and fatigue is not increased in patients with takayasu’s arteritis:

Background Takayasu’s arteritis (TA) is a chronic inflammatory large-vessel vasculitis of the aorta and its major branches. To our knowledge, there is no data about the frequency of Fibromyalgia Syndrome (FM), a systemic pain disorder, in TA. Objectives We aimed to investigate the frequency of FMS in TA defined according to the 2010 ACR Preliminary Diagnostic Criteria for FM. The correlation between ACR-1990 and 2010 FM criterias and the effect of patient-reported outcomes (PROs) such as Health Assessment Questionnaire (HAQ), Multidimensional Assessment of Fatigue Scale (MAF), Short-Form 36-item survey (SF-36) and anxiety and depression scales on FM were also analysed. Methods We studied 42 patients with TA (F/M: 38/4, mean age: 30.8 years) and 20 (F/M: 11/9, mean age:32.8 years) healthy controls (HC). Fourteen patients (33,3%) were clinically active. All patients were examined for FM tender points (ACR 1990 criteria for classification for FM) by two observer (kappa: 0.648) and asked to complete new ACR 2010 FM questionnaire for FM (ref1). PROs were used to assess quality of life together with HAQ. Results Seven (16.6%) TA patients and 3 HC (15%) met the ACR-2010 FM criteria, whereas only 3 (7,1%) patients and no controls (0%) met the 1990 Criteria. No significant differences regarding the FM frequency were present according to both ACR-2010 and 1990 FM criterias between TA and HC. No differences were also observed for the 2 subscales of 2010 criteria, the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale among the groups. FM presence was also similar between active and inactive patients (p:0,143).The SF-36 physical component score (PCS) were significantly lower [TA:45,85 (18-62), HC: 55,5 (31-59), p=0.009] and HAQ score significantly higher in patients with TA [0,175 (0- 2,35)]compared to HC[0,005 (0-0,45)] (p<0,001). No differences were present in other PROs (Table 1). WPI correlate significantly with tender points (r=0,728, p<0,001), MAF (r=0,692, p<0,001), HAQ (r=0,539, p<0,001), anxiety (r=0,442, p<0,001), depression (r=0,475, p<0,001), PCS (r= -0,629, p<0,001) and MCS (r=-0, 468, p<0,001). SSS correlate significantly with tender points (r=0,508, p<0,001), MAF (r=0,773, p<0,001), HAQ (r=0,4999, p<0,001), anxiety (r=0,618, p<0,001), depression (r=0,498, p<0,001), PCS (r= -0,617, p<0,001) and MCS (r=-0,629, p<0,001). Table 1. 1 Results of the FM and other patient-reported outcomes in TA and controls Takayasu’s arteritis (n=42) Healthy controls (n=21) P values SS 6 (0-13) 4 (0-9) 0,201 WPI 1 (0-16) 1 (0-9) 0,613 Tender points 1 (0-15) 1 (0-9) 0,798 MAF 23,12 (0-50) 15,25 (0-33) 0,178 Anxiety scale score 5,5 (0-21) 4 (0-18) 0,244 Depression scale score 3 (0-21) 4 (0-14 0,988 MCS 45,7 (23-65) 50,1 (21-62) 0,503 Conclusions The frequency of FM is similar to general population in patients with Takayasu arteritis. The new ACR-2010 FM criteria seem to be more sensitive than the ACR-1990 criteria for diagnosis. Although other PROs also does not differ from HC, the new FM criteria subscales WPI and SSS significantly correlated with scales such as SF-36, MAF, anxiety and depression scale and HAQ in TA, suggesting that in a minority of patients with FM and TA, PROs are affected with FM presence. References Wolfe F, Clauw DJ, Fitzcharles MA, et al. The ACR preliminary diagnostic criteria forfibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken). 2010 May;62(5):600-10. Disclosure of Interest None Declared

Prevalence of inflammatory back pain and radiologic sacroiliitis is increased in patients with primary Sjögren’s syndrome

Introduction The prevalence of Sjögrens syndrome (SS) in patients with the diagnosis of SpA has been reported to be higher than normal population. Yet, the vice-versa is unclear. In this study, we aimed to investigate the prevalence of IBP, radiologic sacroiliitis and SpA in patients with primary SS. Methods 85 patients followed at the rheumatology clinics of the Marmara and Kocaeli Universities with the diagnosis of primary SS between November 2011 and August 2012 were included in this study. The control group consisted of 100 age-and gender-matched patients. Inflammatory back pain and axial SpA were diagnosed according to the assessment of spondylo arthritis International Society (ASAS) criteria. Results 83 patients were (97%) female and 2 (3%) were male. Mean age of the patients was 49.1 (±11) years. Mean disease duration was 7.3 (±4) years. The patient and control groups were comparable in terms of age and gender (p > 0.05). Inflammatory back pain was observed in 21 (24.7%) of 85 primary SS patients and in 4 (4%) of 100 control subjects (p < 0.001), radiographic sacroiliitis was demonstrated in 9 (10.5%) of primary SS patients and 2 (2%) of the control subjects (p = 0.025). Remaining SpA findings were not encountered in either group. Conclusion inflammatory back pain and radiologic sacroiliitis is increased in patients with primary SS. Whether IBP, SI joint inflammation and radiologic sacroiliitis is due to the co-existence of SpA and primary SS or IBP is an underdiagnosed clinical feature of SS deserves further studies of large patient numbers.