Background: Research in various chronic rheumatic conditions has indicated a high prevalence of comorbidities, and the presence of multiple comorbidities is linked to unfavorable outcomes. The same applies to psoriatic arthritis (PsA), a disease with higher prevalance of cardiovascular and other comorbidities which is associated with poorer outcomes [1]. Objectives: In this assessment, we aimed to define the rate of rheumatic and non-rheumatic comorbidities using national health registry. Methods: Datasystem and patients selection; A nationwide cohort assessment was conducted using the Turkish National Health Data System, which utilizes health data warehouses established by the Ministry of Health since 2014. These warehouses, facilitated through computer applications, cover the entire country and draw data from the Turkish Ministry of Health National Electronic Database (E-Pulse), operational nationwide since 2016. The E-Pulse system encompasses clinical records of over eighty million individuals in Turkey, comprising demographic details, laboratory results, drug histories, and comorbidities. In this analysis, cases of PsA were identified using ICD-10 codes (M07, M09, their subgroups), with cases defined as patients having the respective ICD-10 codes entered at least twice with a 30-day interval.Comorbidities; Comorbidity was considered to be present in patients with the same disease ICD-10 code entered at least 3 times without a time limit. Glucose intolerance (HgA1c ≥ 6.5%), hypertension, hyperlipidemia, thrombosis (venous or arterial), chronic liver disease, hepatitits B and C, kidney disease, lung diseases, chronic depression, fibromyalgia, cancer were determined as non-rheumatic comorbidities and connective tissue overlap was determined for rheumatic comorbidity assessment. Results: Overall, there were 40.643 (26.696 female 65.9%) PsA patients in Turkey between 2016-2022. Hypertension (41.0%) and depression (27.4%) were the most common co-morbid conditions in all PsA patients. Any connective tissue disorders was comorbid in approximately 2% of patients. Any CTD, especially Sjögren’s syndrome, asthma, neuropsychiatric syndromes (depression and fibromyalgia) were more common in female PsA patients (Figure 1). Cardiovascular disease, COPD, kidney disease and hepatitis are more common in men. Comorbidities such as malignancy and thrombosis, which are important in treatment selection, are similar in both gender Conclusion: In international treatment recommendations, comorbidities are a prominent condition in treatment management. Gender also plays a decisive role in the prominence of comorbidities. As a matter of fact, while malignancy and thrombosis, which may be decisive in treatment decision-making, are equally present in both sexes, neuropsychiatric diseases and concomitant CTDs, which will come to the fore in patient evaluation, are more prominent in women. This should be taken into consideration when making treatment decisions. REFERENCES: [1] Gupta S, Syrimi Z, Hughes DM, Zhao SS. Comorbidities in psoriatic arthritis: a systematic review and meta-analysis. Rheumatol Int. 2021 Feb;41(2):275-284. doi: 10.1007/s00296-020-04775-2. Epub 2021 Jan 9. PMID: 33423070; PMCID: PMC7835184 Acknowledgements: NIL. Disclosure of Interests: None declared.

Background: Rheumatoid arthritis (RA) is a very heterogeneous disease and may show different clinical course according to age group. Therefore, studying treatment choices according to age groups in a nationwide database may add important information. Objectives: In this study, it was aimed to evaluate the differences in demographic characteristics, co-morbid diseases and treatment choices of RA patients at the nationwide health data. Methods: Data and Patient Selection: This nationwide cohort study utilized information from the Turkish Ministry of Health National Electronic Database, E-Pulse. The Ministry of Health employs Big Data technology for service delivery, incorporating integrated systems like E-Pulse and the National Healthcare Information System (NHIS). E-Pulse houses clinical records for over eighty million individuals in Turkey, capturing demographic details, laboratory results, drug history, and comorbidities since 2016. In this analysis, cases of rheumatoid arthritis (RA) were identified using ICD-10 codes M05 ('M05.0', 'M05.1', 'M05.2', 'M05.3', 'M05.8', 'M05.9') and M06 ('M06', 'M06.0', 'M06.1', 'M06.2', 'M06.3', 'M06.4', 'M06.8', 'M06.9') twice, with at least 30 days apart, and with at least one prescription for a disease-modifying antirheumatic drug (DMARD). Cases with spondyloarthritis and/or psoriatic arthritis ICD codes were excluded. Data recorded in the E-Pulse system between January 2016 and December 2022 were utilized for this study. Definitions: The age of the patients at the time of initial presentation was recorded. Patients were analysed in two subgroups. Firstly, those aged > 65 years were grouped as late-onset RA (LORA) and those aged < 65 years were grouped as early-onset RA (EORA). Demographic characteristics, co-morbid diseases, treatment choices according to the two groups. Results: Overall, 347.902 (79.5% female) RA patients registered in the E-Pulse data were analysed. The median age of all, LORA and EORA were 56 years (1-107), 71 (65-107), 51 (1-64) respectively. 90,687 (26.1%) patients were older than 65 years of age when they were first registered in the E-Pulse system. Co-morbidities of LORA vs EORA; Associated auto-immune diseases were less common in LORAs: (Sjogren syndrome 3.9% vs 5.8%, OR 0,66 (0,64-0,69), SLE 1.0% vs 3.6%, OR 0,28 (0,26-0,29), SSc 0.9% vs 1.3%, OR 0,65 (0,60-0,70)). The other comorbidities were LORA vs EORA: Cancer 8.2% vs 4.3%, OR 1,98 (1,92-2,04), DM 23.4% vs 14.2%, OR 1.85 (1.81-1.88), HT 83.3% vs 45.6%, OR 5,94 (5,83-6,06), hyperlipidemia 23.8% vs 12.5%, OR 2.19 (2.15-2.32), thrombosis 4.4% vs 2.4%, OR 1,88 (1,80-1,95), PTE 1.1% vs 0.5%, OR 2,34 (2,15-2,54), aneurysm 0.7% vs 0.3%, OR 2,24 (2,02-2,49), COPD 14.6% vs 4.3%, OR 3.82 (3.72-3.92), ILD 1.4% vs 0.6%, OR 2,41 (2,24-2,59), chronic renal failure 6.1% vs 2.1%, OR 3,09 (2,98-3,22), total hip prosthesis 1.3% vs 0.9%, OR 1,47 (1,37-1,57), total knee prosthesis 7.3% vs 3.3%, OR 2,34 (2,26-2,41) and mortality 23.6% vs OR 4.0%, 7,48 (7,30-7,67). Treatment choices of LORA and EORA: Among synthetic DMARDs, methotrexate (50.1% vs 58.0%), sulfasalazine (28.3% vs 32.6%) and hydroxychloroquine (56.9% vs 64.6%) were less preferred in geriatric age group, while leflunomide (37.7% vs 32.0%) was used slightly more frequently. The use of bDMARDs, bDMARD switch, were significantly less in the geriatric age. Relatively, abatacept and rituximab were preferred more than other bDMARDs in the geriatric age (Table 1). Conclusion: In conclusion, RA in geriatric age includes approximately one quarter of all patients and the comorbid conditions accompanying them probably influence their choice of treatment. As expected, co-morbid conditions accompanying RA patients include metabolic diseases, thrombosis, cancer, chronic kidney and chronic lung diseases, which increase with age. Both synthetic and b/tsDMARDs were less favoured in geriatric age. Importantly, abatacept and rituximab were preferred slightly more frequently in geriatric age, which may be related to safety profile or ease of administration. REFERENCES: NIL. Table 1. Distribution of DMARDs used according to age group at first presentation Acknowledgements: NIL. Disclosure of Interests: None declared.

Background: Recently, the characteristics of patients with difficult-to-treat (D2T) psoriatic arthritis (PsA) have been emphasized increasingly. However, the definition of D2T in patients with PsA is still unclear. Objectives: In this study, we aimed to determine the clinical and demographic characteristics of patients with difficult-to-treat PsA registered in the national health registry dataset. Methods: Datasystem and patients selection; A comprehensive evaluation of a nationwide cohort was carried out using the Turkish National Health Data System, which relies on health data repositories established by the Ministry of Health since 2014. These repositories, operated through computer applications, extend coverage across the entire country and extract information from the Turkish Ministry of Health National Electronic Database (E-Pulse), which has been operational nationwide since 2016. The E-Pulse system contains clinical records for more than eighty million individuals in Turkey, encompassing demographic details, laboratory results, drug histories, and comorbidities. In this analysis, instances of Psoriatic Arthritis (PsA) were identified through ICD-10 codes (M07, M09, and their subgroups), with cases defined as patients having the respective ICD-10 codes entered at least twice with a 30-day interval. For comorbidity analysis, comorbidity was considered to be present in patients with the same disease ICD-10 code entered at least 3 times without a time limitDefinition of D2T: The dificult to treat PsA was defined as PsA patients prescribed ≥2 different mechanisms with biologic disease-modifying anti-rheumatic drugs. [1] Demographics, comorbidities and treatment strategies were assessed in this group and comparisons were made between patients with only 1 bDMARD usage. Results: From the cohort of 40.463 PsA patients 11.923 (29.4%) used at least one bDMARDs. Overall, 2.605 (6.4% of all PsA patients, 21.8% of patients using bDMARDs) were defined as difficult-to-treat PsA. The distribution of the groups according to the number of drugs used was as follows: two bDMARDs n:2.524 (%21.2), three bDMARD n:1.138 (%9.5), four bDMARD n:455 (%3.8), ≥5 (%2.5).There were no differences in CTDs, glucose intolerance, hyperlipidemia, pulmonary or renal diseases, malignancies, or thrombosis between patients who used one bDMARD and patients who used two or more bDMARDs. On the other hand, neuropsychiatric disorders were more frequent in patients who used two or more bDMARDs [depression 32.3% vs 26.1%, OR 95% CI 1.35 (1.23-1.48), fibromyalgia 12.0% vs 7.5%, OR 95% CI 1.64 (1.42-1.89)]. Patients with difficult-to-treat PsA were more likely to use csDMARD and glucocorticoids (Table 1). Conclusion: Approximately 6% of all PsA patients in the national health register and about one-fifth of patients on bDMARDs used two or more different mechanisms bDMARDs. The main determinant factor is the presence of depression and fibromyalgia, which is slightly higher in women. Although causality cannot be demonstrated according to our data, special care should be taken in this patient group. REFERENCES: [1] Philippoteaux C, et al. Characteristics Of Difficult-To-Treat Psoriatic Arthritis: A Comparative Analysis. Semin Arthritis Rheum. 2023 Dec;63:152275. Acknowledgements: NIL. Disclosure of Interests: None declared.Table 1Characteristics of difficult-to-treat PsA patientsN (%)bDMARD=1n (%)N: 9.220Difficult to treat PsA, n(%)N: 2.605Odds RatioAge, years, mean (SD)44.27 (12.7)43.86 (11.7)N.AFemale gender5.667 (61.45)1771 (65.54)1.19 (1.09-1.31)Glucocorticoid use5.889 (63.9)1863 (71.5)1.48 (1.35-1.63)Use of csDMARDs Methotrexate Leflunomide Sulphasalazine7.824 (84.8)6656 (72.1)2975 (32.2)2985 (32.3)2.409 (89.1)2072 (76.6)1132 (41.8)872 (32.2)1.47 (1.28-1.68)1.27 (1.15-1.40)1.51 (1.39-1.65)0.99 (0.91-1.09)

Background: Gastrointestinal tract (GIS) involvement is a leading cause of morbidity in systemic sclerosis (SSc). Non-invasive biomarkers are needed for GI involvement. The role of anti-muscarinic 3 receptor (anti-M3R) antibodies in the pathogenesis of GI tract involvement has been demonstrated. Objectives: The aim of this study was to investigate the relationship between GI uptake characteristics and serum anti-M3R antibodies in SSc patients. Methods: This study was conducted with 41 SSc patients and 5 healthy controls. GI complaints of all patients were questioned. MUST and ESPEN scores were calculated for malnutrition and UCLA SCTC GIT 2.0 scores were calculated for the severity of GI involvement. Sandwich-ELISA test was used to detect anti-M3R antibody (MyBioSource, Inc. San Diego, USA). Anti-M3R antibodies were tested in 39 patients because the blood samples of two patients were haemolysed. The relationship between serum anti-M3R antibody titres and patients' clinical characteristics, GI symptoms and malnutrition scores were evaluated. Results: Thirty-one (85.4%) of the patients were female, 32 (78%) had a diagnosis of limited SSc, mean age was 53.6 ± 13.5 years, median disease duration (IQR) was 15 (6.00-20.50) years. 37 (90.2%) patients had GIS involvement. Anti-M3R antibody was positive in 18 (46.1%) patients. Anti-M3R antibodies were negative in all (n=5) patients with positive anti-centromere antibodies and positive in all (n=4) patients with myositis (Table 1). According to the total UCLA SCTC GIT 2.0 score, no correlation was found between moderate to severe GIT involvement and anti-M3R antibody titres (all parameters, p >0.05). Anti-M3R antibody titres and the number of antibody positive patients were not different between the patient groups with and without risk of malnutrition according to MUST score (all parameters, p>0.05). Anti-M3R antibody titres and the number of antibody-positive patients were not different between the patient groups with and without malnutrition determined using ESPEN criteria (p>0.05). In terms of clinical characteristics, anti-M3R antibody titres were found to be lower in patients with faecal incontinence compared to those without (p=0.05). There was a tendency for higher antibody titres in patients with weight loss compared to those without weight loss, but it did not reach a significant level (p=0.09). The comparison of antibody titres according to clinical and laboratory characteristics is given in Table 2. Conclusion: In this study, a significant rate of anti-M3R antibody positivity was detected in SSc patients. No association was found between anti-M3R antibody positivity or titres and total UCLA SCTC GIT 2.0 score or malnutrition risk. REFERENCES: NIL. Table 1. Demographic and clinical characteristics of systemic sclerosis patients according to anti-M3R antibody positivity Table 2. Anti-M3R antibody titers according to the disease type, autoantibody profile, organ involvement and immunosuppressive therapy usage Acknowledgements: The authors thank all contributors. Disclosure of Interests: None declared.