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Possible association between vitamin D deficiency and restless legs syndrome

Background and aim Restless legs syndrome (RLS) is a distressing sleep disorder that occurs worldwide. Although there have been recent developments in understanding the pathophysiology of RLS, the exact mechanism of the disease has not been well elucidated. An increased prevalence of neurologic and psychiatric diseases involving dopaminergic dysfunction in vitamin D–deficient patients led us to hypothesize that vitamin D deficiency might result in dopaminergic dysfunction and consequently, the development of RLS (in which dopaminergic dysfunction plays a pivotal role). Thus, the aim of this study was to evaluate the relationship between vitamin D deficiency and RLS. Methods One hundred and fifty-five consecutive patients, 18–65 years of age, who were admitted to the Department of Internal Medicine with musculoskeletal symptoms and who subsequently underwent neurological and electromyography (EMG) examination by the same senior neurologist, were included in this study. The patients were divided into two groups according to serum 25-hydroxyvitamin D (25(OH)D) (a vitamin D metabolite used as a measure of vitamin D status) level: 36 patients with serum 25(OH)D levels ≥20 ng/mL comprised the normal vitamin D group, and 119 patients with serum 25(OH)D levels <20 ng/mL comprised the vitamin D deficiency group. The two groups were compared for the presence of RLS and associated factors. Results The two groups were similar in terms of mean age, sex, mean body mass index (BMI), and serum levels of calcium, phosphate, alkaline phosphatase (ALP), and ferritin. The presence of RLS was significantly higher in the vitamin D deficiency group (χ2=12.87, P<0.001). Regression analysis showed vitamin D deficiency and serum 25(OH)D level to be significantly associated with the presence of RLS (odds ratio [OR] 5.085, P<0.001 and OR 1.047, P=0.006, respectively). Conclusion The present study demonstrated a possible association between vitamin D deficiency and RLS. Given the dopaminergic effects of vitamin D, 25(OH)D depletion may lead to dopaminergic dysfunction and may have a place in the etiology of RLS. Prospective vitamin D treatment studies are needed to confirm this relationship and to evaluate the efficacy of vitamin D as a treatment for RLS patients.

FRI0206 Prevalence of Irritable Bowel Syndrome in Patients with Ankylosing Spondylitis

Background Irritable bowel syndrome (IBS) is a functional bowel disease that cannot be explained with an organic pathology, characterized by change in bowel habits and abdominal pain that relaxes with defecation. It is well known that IBS has an increased association with psychosomatic illnesses such as depression, anxiety, chronic fatigue syndrome and fibromyalgia. Similarly, publications are available in the literature that IBS has also an increased association with chronic, painful inflammatory pathologies such as rheumatoid arthritis and systemic lupus erythematosus. And also ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial skeleton, that is characterized by new bone formation can eventually cause ankylosis and limitation of motion and disability. Accordingly, we aimed to assess the prevalence of IBS in patients with AS. Methods The study was conducted at a university hospital rheumatology clinic and 113 consecutive patients with AS according to the modified New York criteria were included. Patients demographics, clinic and laboratory data were recorded. Functional status was evaluated with BASFI (Bath Ankylosing Spondylitis Functional Index), health quality with ASQOL (Ankylosing Spondylitis Health Quality) and disease activity with BASDAI (Bath Ankylosing Spondylitis Activity Index). Then all patients were questioned with diagnosis of IBS and type according to ROME III criteria. The mean and standard deviation values for continuous variables were given. Categorical variables were expressed as percentage. While Mann-Whitney U test was used for comparison of continuous variables between two groups, chi-square test was used for categorical variables. P<0.05 was considered statistically significant. Results Clinical and demographic characteristics of the patients are given in the table. Prevalence of IBS in patients with AS was found to be 30.1%. The distribution of types of IBS is following; 38% alternating diarrhea and constipation type, 23% constipation dominant type, 21% diarrhea dominant type and 18% mixed type. Frequency of IBS was found to be significantly higher in higher disease activity group (BASDAI>4) and in patients treated with biologic agents. (p values <0.001, 0.017, respectively). Prevalence of IBS between the sexes was found to be significantly higher in female patients (p: 0.031). Conclusions IBS; when compared to the normal population was found to be higher (%30) in patients with AS. In a similar manner to the community, frequency of IBS is significantly higher in female patients, although AS is more frequent in male patients. As a result, in patients with AS, especially with high disease activity, gastroenterological complaints should be questioned; and the diagnosis of IBS should not be ignored in the treatment process. Disclosure of Interest None declared

AB0944 Vitamin D Deficiency Might Contribute Fatigue and Disease Activity in Patients with Fibromyalgia

Background Fibromyalgia syndrome (FMS) is a chronic musculoskeletal system disease characterized by widespread pain and allodynia in at least 11/18 anatomic regions. Other important symptoms are fatigue, sleep disturbance and cognitive impairment. Widespread pain and fatigue can also be seen in patients with vitamin D deficiency. The association between low levels of 25-hydroxy (OH) vitamin D and non-specific musculoskeletal pain, including fibromyalgia syndrome, is controversial. Objectives The aim of this study is to assess fatigue and health quality in patients with isolated FMS, isolated vitamin D deficiency and FMS in together with vitamin D deficiency. Methods Patients followed by rheumatology clinic and classified as FMS according to ACR 2010 criteria were included in this study. 25- OH vitamin D levels below 20 ng/ml were accepted as vitamin D deficiency. Study groups classified as first group; patient with isolated FMS, second group; isolated vitamin D deficiency and third group was FMS in together with vitamin D deficiency. Patients with known calcium abnormality, hyperparathyroidism and osteomalacia were excluded. Fatigue level was measured by the visual analog scale (VAS) and functional assessments were determined by using BASFI and HAQ. Routine laboratory data were recorded. Widespread Pain Index (WPI); by evaluation of 0-19 tender points and Symptom Severity Score (SS); by the sum of fatigue, sleep, cognitive disturbances with general somatic symptoms were obtained. Results Patients distribution according to groups and properties were summarized in the table. As expected, in all groups, the majority of patients were female. While fatigue levels were similar between isolated vitamin D deficiency group and isolated FMS group, in FMS together with vitamin D deficiency group fatigue level was measured higher than the other two groups. Moderate and negative correlation was detected between fatigue level and vitamin D level (r:- 413, p:0,002). Negative relation was also detected between widespread pain index and symptom severity score with vitamin D level (r: -0.325, p: 0.023; r: -0.315, p: 0.037 respectively). HAQ and BASFI scores were higher with D vitamin deficiency between FMS patients (respectively p: 0.018, p<0.001). Group 1: Group 2: Group 3: Isolated vitamin D deficiency (n=37) Isolated FMS (n=21) FMS and vitamin D deficiency (n=43) Age, mean ± SD 49±13.0 45±6.6 47±9.9 Gender, female % 32, 86.5 21, 100 43, 100 ESR mm/h; mean ± SD 15±8.8 19±10.5 18±9.5 CRP mg/L; mean ± SD 2.3±2.4 3.9±3.1 4.1±1.8 25-Hydroxy vitamin D, ng/ml; mean ± SD 11.6±5.3 34.6±12.0 11.3±4.7 Ca mg/dl; mean ± SD 9.7±0.3 9.6±0.2 9.6±0.3 P mg/dl; mean ± SD 3.3±0.4 3.4±0.5 3.6±1.1 PTH pg/ml; mean ± SD 54±20.0 52±9.9 52±25.1 ALP IU/L ; mean ± SD 74±21.2 69±19.2 83±24.5 BASFI; mean ± SD 2.0±0.9 2.6±1.5 4.5±1.8* HAQ; mean ± SD 0.6±0.9 0.8±0.4 1.2±0.3* VAS fatigue; mean ± SD 54±22 59±10 76±15* WPI score; mean ± SD N/A 10±1.5 12±2.1 SS score; mean ± SD N/A 6±1.2 8±1.5 Conclusions Vitamin D deficiency may contribute disease severity, fatigue and disturbances in health quality in FMS patients. Based on this, in FMS screening the level of vitamin D and correction may be helpful in symptom control. Disclosure of Interest None declared

FRI0196 CCR2 Expression was Increased in Patients with Ankylosing Spondylitis Independent from Disease Activity

Background Ankylosing Spondylitis (AS), with poorly understood pathogenesis, is a chronic inflammatory rheumatic disease, and as a result of inflammation, morbidity and mortality may occur. Many cell types are involved in inflammatory process, and particularly antigen presentation is important. Monocytes are also one of the most important sources of antigen presenting cells, activated by inflammation and chemotactic stimulation, reach the inflammatory focus through the vessel wall and become macrophage, a cell type which has more highly phagocytic ability. There are two main monocyte populations in peripheral blood. First, forming a smaller population, less mature, has a lower volume and higher tumoricidal activity cells (CD14+/CD16+), second and higher population, consist of more mature monocytes; this monocytes have a higher volume, and they get more actively involved in antibody dependent cellular cytotoxicity (CD14+/CD16-). CCR2 is a chemokine expressed on monocytes, and in inflammatory condition they play an important role on extravasation and transmigration of monocytes. Objectives The aim of this study is to evaluate phenotypes and determine the distribution according to disease activity of monocytes, important source of antigen presenting cells, in patients with AS. Methods Patients classified as AS according to modified New York criteria and healthy controls were included. Patients on biologic treatment have an active infection, or known chronic diseases were excluded. Besides routine clinic laboratory evaluation, to determine subtypes and activation status of monocytes, flow cytometry analyzes were performed on peripheral blood. In multi- colored analyze CD14-FITC, CD16-PE and CCR2-PerCP were used. Monocyte percentages and monocyte subtype were determined. CCR2 expression on monocytes and on monocyte subtypes was studied. Results The demographic characteristics of AS patients and controls were summarized on table. Inflammatory markers were found to be significantly higher in patients with AS. Apart from percentages of CD14+/CD16+ and CD14+/CD16- subtypes which were similar between two groups, CCR2 expression was detected significantly higher in AS patients in both subgroups. There was no difference between monocyte subgroups and CCR2 expressions when classified according to disease activity in patients with AS. Table 1 AS (n=47) Control (n=20) P Age, mean ± SD 39±9.3 37±7.3 >0.05 Sex, male % 37, 78.7 16, 80.0 >0.05 BASDAI, mean ± SD 3.9±2.2 N/A ASDAS-CRP, mean ± SD 2.9±1.0 N/A hs-CRP μg/ml, mean ± SD 4.7±7.6 0.8±1.9 <0.001 IL-6 pg/ml, mean ± SD 40.9±231 1.9±0.3 <0.001 HLA B27 positivity, n/% 29/43,67.4 N/A WBC, 103/μl median (range) 7600 (5200–16300) 6100 (4300–10200) 0.001 Monocyte, 103/μl, median (range) 351 (114–1274) 356 (151–496) >0.05 CD14+/CD16+, % 7.2±6.8 5.0±3.0 >0.05 CD14+/CD16−, % 92.5±6.8 94±3.0 >0.05 CD14+/CD16+/CCR2, % 44±21.6 12.1±12.0 <0.001 CD14+/CD16−/CCR2, % 70±20.4 21.6±12.8 <0.001 Conclusions In our study, compared to control group, CCR2 expression on monocyte subgroups was significantly higher independent from disease activity in patients with AS. We believe, this may contribute to the understanding of inflammatory process in AS patients. Disclosure of Interest None declared