P. Cetin

Efficacy of interleukin-1 targeting treatments in patients with familial mediterranean Fever.

Herein, we reported our experience in colchicine-resistant familial Mediterranean fever (FMF) patients who are treated with anti-interleukin-1 (IL-1) drugs. A retrospective review of medical records of anti-IL-1 recipients was performed. The main clinical characteristics of these patients and the evolution after anti-IL-1 were recorded. There were 20 patients (11 male [M] and 9 female [F]). Despite regular colchicine treatment, median number of attacks per month and per year was 1 (1–4) and 12 (4–50), respectively. Twelve patients were receiving anakinra, and eight patients were treated with canakinumab. The number of monthly and yearly attacks after IL-1 treatment was significantly decreased after the biologic agent (p < 0.05). One patient did not respond to the treatment, and one patient developed serious infection during anti-IL-1. We also observed a significant decrease in proteinuria in the amyloidosis complicated FMF patients. Anti-IL-1 targeting drugs seem safe and effective therapies in colchicine-resistant FMF.

Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis.

[Purpose] This study describes the cultural adaptation, validation, and reliability of the Turkish version of the Pain Catastrophizing Scale in patients with ankylosing spondylitis. [Methods] The validity of the Turkish version of the Pain Catastrophizing Scale was assessed by evaluating data quality (missing data and floor and ceiling effects), principal components analysis, internal consistency (Cronbach’s alpha), and construct validity (Spearman’s rho). Reproducibility analyses included standard measurement error, minimum detectable change, limits of agreement, and intraclass correlation coefficients. [Results] Sixty-four adult patients with ankylosing spondylitis with a mean age of 42.2 years completed the study. Factor analysis revealed that all questionnaire items could be grouped into two factors. Excellent internal consistency was found, with a Chronbach’s alpha value of 0.95. Reliability analyses showed an intraclass correlation coefficient (95% confidence interval) of 0.96 for the total score. There was a low correlation coefficient between the Turkish version of the Pain Catastrophizing Scale and body mass index, pain levels at rest and during activity, health-related quality of life, and fear and avoidance behaviors. [Conclusion] The results of this study indicate that the Turkish version of the Pain Catastrophizing Scale is a valid and reliable clinical and research tool for patients with ankylosing spondylitis.

A Nationwide Experience With The Off‐label Use of Interleukin‐1 Targeting Treatment in Familial Mediterranean Fever Patients

Approximately 30–45% of patients with familial Mediterranean fever (FMF) have been reported to have attacks despite colchicine treatment. Currently, data on the treatment of colchicine‐unresponsive or colchicine‐intolerant FMF patients are limited; the most promising alternatives seem to be anti–interleukin‐1 (anti–IL‐1) agents. Here we report our experience with the off‐label use of anti–IL‐1 agents in a large group of FMF patients.

Do major histocompatibility complex tag single nucleotide polymorphisms accurately identify HLA-B27 in the Turkish population?

To evaluate the performance of human leukocyte antigen (HLA)‐B27 tag single nucleotide polymorphisms (SNPs) by polymerase chain reaction – restriction fragment length polymorphism (PCR–RFLP).

Increased Frequency of Hand Osteoarthritis in Patients with Primary Sjögren Syndrome Compared with Systemic Lupus Erythematosus.

Objective. In daily practice, we noticed that hand osteoarthritis (OA) was commonly associated with primary Sjögren syndrome (pSS). Therefore, we aimed to investigate its prevalence in patients with pSS in a controlled study. Methods. The study included patients with pSS and controls with systemic lupus erythematosus (SLE). Standard hand/wrist radiographs were obtained and classified according to the Kellgren-Lawrence system. “Erosive hand OA” was defined according to the Verbruggen-Veys classification. Results. There were 114 patients with pSS (110 women, 51.0 yrs) and 34 patients with SLE (33 women, 42.4 yrs). Among 114 patients with pSS, 42.7% had radiographic, 30.3% symptomatic, and 16.0% erosive hand OA. The prevalences of radiographic (45.5%) and erosive hand OA (14.4%) in 90 patients with pSS with age- and sex-matched patients with SLE were significantly higher than those in patients with SLE (14.7% and 0.0%, p = 0.007 and p = 0.012, respectively). Interobserver reliabilities for diagnosing radiographic and erosive OA were found to be good (ĸ = 0.780 and ĸ = 0.788, respectively). Intraobserver reliabilities for diagnosing radiographic and erosive OA were also good (ĸ = 0.784 and ĸ = 0.825 for FO, and ĸ = 0.722 and ĸ = 0.800 for AB, respectively). The frequency of hand OA in patients with pSS was found to be increased with increasing age (r = 0.513). The mean age of those with erosive hand OA was significantly higher than those without erosive OA (p < 0.001). Conclusion. This study suggests that pSS, conversely to SLE, is more frequently associated with hand OA.

Prevalence of Inflammatory Back Pain and Axial Spondyloarthritis Among University Employees in Izmir, Turkey

Objective. To estimate the prevalence of inflammatory back pain (IBP) and axial spondyloarthritis (axSpA) using the Assessment of SpondyloArthritis International Society (ASAS) classification criteria among employees in a university. Methods. In the first stage of the study, a face-to-face interview was done using a standard questionnaire to investigate IBP in 381 subjects randomly selected from 2894 employees at Dokuz Eylul University in Izmir, Turkey. In the second stage, subjects with back pain for ≥ 3 months and age at onset < 45 years were evaluated for axSpA using the ASAS criteria. Both the European Spondyloarthropathy Study Group (ESSG) criteria and Amor criteria were used for the classification of the whole group of spondyloarthritis (SpA). Results. There were 131 male and 250 female subjects (mean age: 38.0 yrs). Twenty-five subjects (6.6%) were classified as having IBP according to the ASAS criteria. The prevalence of IBP according to the Berlin and Calin criteria was 7.1% and 21.5%, respectively. The prevalence of axSpA was estimated at 1.3% according to the ASAS classification criteria (0.5% for radiographic axSpA and 0.8% for nonradiographic axSpA). A total of 7 patients (1.8%) fulfilled both the Amor and ESSG criteria for the whole group of SpA. Conclusion. This is the first prevalence study of IBP and axSpA using ASAS classification criteria in the Turkish population. The prevalence estimates of IBP and axSpA reported here are within the upper range of other studies in European countries and the United States.

Tophaceous gout causing internal derangement of knee joint.

Chronic gout is characterized by tophi, which are the collections of monosodium urate crystals and frequently located in subcutaneous and synovial tissues. Although the knee is the third most commonly involved joint and intra-articular and periarticular tophi deposition has been previously reported, internal derangement due to tophaceous gout is very unusual. Here we describe a patient with multiple tophi causing knee joint derangement shown by magnetic resonance imaging. A 53-year-old man presented with pain and locking sensation in the right knee particularly when he walked down stairs. He has intermittent acute monoarthritis for 10 years. He noticed that arthritis attacks were mostly related with the consumption of alcoholic beverages and shellfish. On physical examination, there was soft tissue swelling in both olecranon bursae (A) compatible with tophi. His right knee was both swollen and deformed, and range of movement was restricted. Anterior drawer test was positive in the right knee. Laboratory analysis showed a serum uric acid level of 10.2 mg/dL. Anteroposterior (B) and lateral (C) radiograph of the right knee showed narrowing of medial joint space, osteophytic new bone formation, and subchondral lucencies. On the posterior side of the joint, multiple rounded opacities were observed, suggesting synovial chondromatosis. Sagittal T1-weighted (E) and T2-weighted (F) magnetic resonance imaging scans demonstrated subchondral cystic changes of the bone and some intermediate signal intensity areas inside the bone that were compatible with intraosseous tophi (dashed arrows) causing the buckling of the posterior cruciate and discontinuation of the anterior cruciate ligament. High-density opacities observed on radiographs were shown to be articular surface tophi (arrows). Analysis of synovial fluid revealed a leukocyte count of 200/HL and needle-shaped crystals in light microscopic examination (D). The patient was diagnosed with chronic tophaceous gout and put on allopurinol and colchicine treatment.

Phenotype Differences in HLA-B27 Positive Versus Negative Patients with Ankylosing Spondylitis in a Population That Show Relatively Weaker Association with HLA-B27

For a searchable version of these abstracts, please visit www.acrabstracts.org.

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

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