Introduction. The coronavirus disease (COVID-19) pandemic has the potential to impact disease activity and psychological well-being in people with rheumatic diseases. This study aimed to compare ankylosing spondylitis (AS) patients with and without COVID-19 history in terms of treatment, disease control, quality of life and psychological status by providing a cross-sectional look at treatment, disease control, quality of life and psychological status in patients with AS during the COVID-19 pandemic. Methods. The study included 74 AS patients, in two groups based on COVID-19 history. Demographic data and clinical characteristics were recorded. Treatment, disease control, functional status, and quality of life were evaluated using Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index (BASFI), and impact of COVID-19 on quality-of-life scales. Psychological status was assessed using the Beck Depression Inventory, Beck Hopelessness Scale, and COVID-19 anxiety scale. Results. Of the 74 patients diagnosed with AS, 44 were female and 34 were male. The mean age was 47.3 years. In total, 35 patients (47.3%) had COVID-19. We found that the group without COVID-19 had significantly higher levels of hypothyroidism than the other group (p = 0.008). The BASFI value was significantly higher in the COVID-19 group (p = 0.031). The group with COVID-19 had a substantially higher rate of continuing non-anti-rheumatic drug use than the other group (p = 0.02). Conclusion. During COVID-19 pandemic period, the majority of patients continued their medication, so treatment and disease control were not negatively affected. Having COVID-19 did not cause a significant difference psychologically.

Objectives To evaluate the radiological, clinical and functional properties of hand osteoarthritis and to assess their relationship in a Turkish population. Methods The subjects with hand OA recruited into the study from the multi-centre national osteoarthritis cohort by the Turkish League Against Rheumatology (TLAR–OA). The demographic characteristics, body mass index (BMI), smoking, finger ratio,(2nd to 4th finger lenght), grip strengths with Jamar dynamometer, hand pain duration (month), hand pain severity (visual analogue scale; 0–100 mm) were evaluated. The radiological stage of hand OA was assessed according to the Kellgren Lawrence OA staging. The hightest stage among the joints involvement was noted as the OA stage of the hand. The functional disability concerning to hand involvement was assessed with Duruöz Hand Index (DHI). The SPSS 24.0 statistical package was used for analysis. The descriptive analysis was performed for all parameters. Spearman’s correlation coefficient was used to assess the relation between quantitative variables. Results A total of 364 subjects (330 female, 34 male) from 15 centres with mean of age 62.96 (SD: 10.22) were recruited into the study. The mean of BMI was 29.54 (SD: 4.51) and the percentage of smoking person was 6.3%. The mean of 2nd finger to 4th finger ratio of the patients was 0.96 (SD: 0.05). The mean of grip strengths of the right hand and left hand were respectively 15.55 kg (SD: 12.88) and 14.13 kg (SD: 11.39), which is lower than normal population.1 The median pain duration of hand was 24 months (min-max: 1–480 months). The mean VAS score of pain was 5.05 (SD: 2.33). The mean DHI score was 16.82 (SD: 15.53). The patients’ radiological OA involvement stages (2,3 and 4) of right and left hands were respectively 26.1% and 23.6% (stage 2); 22.5% and 20.9% (stage 3); 13.2% and 12.4% (stage 4) according to the Kellgren Lawrence scoring. The radiological stages of right and left hands respectively had poor correlation with VASpain (rho=0.152, p=0.010; rho=0.158, p=0.009); low but significant correlations with Duruöz Hand Index (rho=0.257, p<0.0001; rho=0.267, p<0.0001) and low but significant correlations with the duration of pain (rho=0.231, p<0.0001; rho=0.181, p=0.003). There were no significant correlations between the radiological stage of hand OA and BMI, finger ratio, grip strength (p>0.05). Conclusions Although the subjects with hand OA had pain, low grip strenght and hand disability; the radiological findings had meaningful relations with only functional involvement and pain duration in our population. Reference [1] Massy-Westropp N, et al. Hand grip strenght: age and gender stratified normative data in a population-based study. BMC Res Notes2011;4:127. Disclosure of Interest M. T. Duruöz Grant/research support from: ABVIE, Consultant for: NOVARTIS, Speakers bureau: ABDI IBRAHIM, D. Erdem: None declared, T. Tuncer: None declared, L. Altan: None declared, F. Ayhan: None declared, A. Bal: None declared, L. Cerrahoglu: None declared, E. Capkin: None declared, R. Cevik: None declared, D. Dulgeroglu: None declared, S. Gursoy: None declared, S. Hizmetli: None declared, C. Kacar: None declared, E. Kaptanoglu: None declared, T. Kaya: None declared, H. Kocabaş: None declared, K. Nas: None declared, S. Ozcakir: None declared, D. Sindel: None declared, O. Sahin: None declared, G. Tasci Bozbas: None declared, C. Tikiz: None declared, H. Ugurlu: None declared

Background Enthesitis is a primary clinical feature of ankylosing spondylitis (AS). Lower extremity enthesopathy may cause foot pain and functional disability. Detection of enthesitis by using physical examination may be insufficient. Musculoskeletal ultrasonography is a noninvasive and low-cost method for detecting enthesitis readily. Objectives The aims of this study were to evaluate enthesitis by using musculoskeletal ultrasonography and foot disability in patients with AS, to compare healthy controls, and to determine the correlation of enthesitis score and foot function with disease activity and functional status. Methods In this study, 101 patients with AS and 42 healthy controls were examined for enthesal site abnormalities by using gray-scale ultrasonography. The findings were assessed by using the Glasgow Ultrasound Enthesitis Scoring System (GUESS). The foot function index (FFI), which comprised of pain, disability, and activity limitation subscales, was measured in all the patients with AS and healthy controls for assessment of foot function. Disease activity and functional status were assessed using the Bath AS Disease Activity Index (BASDAI) and Bath AS Functional Index (BASFI), respectively, in patients with AS. Results The median GUESS score was 8.00 (1.00–23.00), and, the median total FFI and scores in all the pain, disability, and activity limitation subscales were 14.70 (0.00–75.20), 16.60 (0.00–82.80), 16.10 (0.00–84.40), and 4.00 (0.00–60.00), respectively in patients with AS. The GUESS score, total FFI, and all the subscales scores were significantly higher in the patients with AS than in the controls (p=0.00). GUESS score showed no correlation with BASDAI and BASFI. In patients with AS, total FFI and scores for all subscales showed positive correlations between BASDAI and BASFI, respectively (p=0.00, r=0,66; p=0.00, r=0,0,50; p=0.00, r=0,59; p=0.00, r=0,31; p=0.00, r=0,60; p=0.00, r=0,54; p=0.00, r=0.57; p=0.00, r=0.50). Conclusions The severities of enthesitis and foot disability were higher in patients with AS. Patients with AS may undergo ultrasonographic examination for enthesal foot involvement. Foot disability is related with disease activity and function. Foot involvement and disability should be evaluated comprehensively and managed properly. References Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of enthesal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis 202;61:905–910. Borman P, Koparal S, Babaoğlu S, Bodur H. Ultrasound detection of entheseal insertions in the foot of patients with spondyloarthropathy. Clin Rheumatol 2006;25:373–377. Disclosure of Interest None declared

Background İmpaired sleep quality negatively influences quality of life, morbidity/mortality, and pain perception. Tumor necrosis factor-alpha (TNF-α), which plays a role in the pathogenesis of rheumatoid arthritis (RA), is also a functional cytokine in sleep regulation (1,2). Anti-TNF-α treatment is effectively used in RA treatment Objectives The aims of this study were to evaluate sleep quality in RA patients, determine the relationship between sleep disorders and disease activity, and investigate the effects of anti-TNF-α therapy on sleep. Methods We evaluated 35 RA patients; 22 had a high disease activity and were included in the study group, and 13 were in remission and were included in the control group. The disease activity index-28 (DAS 28) was used to measure disease activity. Patients in the study group were evaluated at the beginning and at week 12 of therapy; control patients were only evaluated at the beginning of the study. The Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) findings (total sleep time, sleep latency, sleep efficiency, number of awakenings after sleep onset, apnea hypopnea index (AHI), periodic leg movements, and snoring) were used to assess sleep quality and disturbance. Results Sleep quality disturbances, evaluated by the PSQI, were present in 60% of the study participants. The median PSQI value was significantly higher in patients with high disease activity than in patients in the remission group (p=0.026). After treatment with anti-TNF-α, the median PSQI value significantly improved (p=0.012) in the high disease activity patients. In the PSG examination, 82.9% of the study patients demonstrated obstructive sleep apnea syndrome (OSAS), 83% demonstrated snoring, and 45.7% demonstrated periodic leg movements. There were no significant differences in the PSG parameters between the patients with high disease activity and those in remission, or between the before and after treatment measurements in patients receiving anti TNF-α therapy (p>0.05). Conclusions Sleep quality, as measured by the PSQI, was impaired in the majority of the RA patients. Sleep disorders were more obvious in patients with high disease activity, but improved after anti TNF-α treatment. On PSG, most RA patients demonstrated OSAS, altered lengths of sleep stages, periodic leg movements, and snoring, but these findings were not related to disease activity and remained unchanged after anti TNF-α treatment. These results suggest that PSQI and PSG evaluations measure different sleep properties. However, these results also support a relationship between RA sleep disorders and the cytokines and mediators that play roles in disease pathogenesis rather than disease activity. These data suggest that sleep disorders in RA patients should be evaluated by both clinical and laboratory measurements. In particular, early detection and treatment of OSAS, which contributes to mortality and morbidity, is important in RA. References Hirsch M, Carlander B, Verge M. Objective and subjective sleep disturbances in patients with rheumatoid arthritis: a reappraisal. Arthritis Rheum 1994;37:41-9 Isomaki P, Punnnonen J. Pro-and anti-inflammatory cytokines in rheumatoid arthritis. Ann Med 1997; 29:499-507 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4023

BACKGROUNDVarious lumbar exercise programs are prescribed for rehabilitation purposes following microdiscectomy applied for the treatment of lumbar disk herniation. The literature contains several studies on this subject. However, there are no studies investigating the effects of supervised dynamic lumbar stabilization exercises on fear and fear/regression attitudes of patients and on their return to work.AIMThis study investigates the effects of supervised dynamic lumbar stabilization exercises during postoperative rehabilitation on spinal mobility, pain, functional status, return to work, quality of life, and fear/regression attitude of patients who underwent lumbar microdiscectomy for the first time.SETTINGThe study was conducted at physical therapy and rehabilitation clinics.STUDY DESIGNA randomized clinical trial comparing exercise programs after lumbar microdiscectomy.PATIENTS SAMPLEForty-four lumbar microdiscectomy patients were randomized into two groups.OUTCOME MEASURESEach group was assessed in terms of low back pain, leg pain, spinal mobility, Oswestry Disability Index (ODI), and Nottingham Health Profile (NHP), at the postoperative first, second, and sixth months. Fear/regression beliefs and level of pain were evaluated through the Fear Avoidance Belief Questionnaire (FABQ).METHODSForty-four patients were randomly divided into two equal groups of 22 subjects, respectively, as a study group with Dynamic Lumbar Stabilization (DLS) exercises and home exercises, and a control group with only home exercises for a period of four weeks.RESULTSLeg pain decreased more in the study group compared with the control group (P=0.004). Spinal mobility scores demonstrated greater increases in the study group (P<0.001). Statistically greater reductions were observed in the study group regarding ODI and FABQ scores (P<0.017).CONCLUSIONDLS exercises may be recommended to patients following spinal surgery due to their benefits in reducing pain, increasing spinal mobility, and ensuring faster return to work periods.

Background: Arthritis in familial Mediterranean fever (FMF) is typically monoarticular, of sudden onset, self-limiting, rarely destructive, and a frequent manifestation of FMF. The mechanisms governing the initiation and resolution of this highly inflammatory disease entity are not fully understood. Therefore, to decipher the complexity of articular autoinflammation, we defined inflammatory cells and some mediators of inflammation and apoptosis in the synovial membrane of a patient with FMF. Methods: A synovial tissue sample obtained from an inflamed hip joint of a boy homozygous for mutation M694I in pyrin/marenostrin was studied by immunohistochemistry using commercially available antibodies specific for tryptase, CD68, CD3, CD20 and CD138. With the same technique, we also analyzed the expression and distribution of myeloperoxidase, lysozyme, galectin-1, galectin-3, p65 (RelA)/NF-κB, iNOS, COX-2 and activated caspase-3. Results: Abundant neutrophils, macrophages and mast cells, but also B cells were observed, which were more numerous than T lymphocytes or plasma cells. Neutrophils had no granules containing myeloperoxidase or lysozyme in their cytoplasm. Galectin-1 was found in many mononuclear cells sparse throughout the synovial tissue, whereas the expression of galectin-3 was less prominent and scattered. Neither of the galectins was detected in neutrophils. p65 (RelA)/NF-κB and iNOS were both up-regulated in most of the inflammatory cells, whereas COX-2 expression was low, and cleaved caspase-3, used as proxy to demonstrate intrinsic apoptosis, was undetectable. Conclusions: The exquisitely inflammatory, yet non-destructive character of FMF arthritis may correlate with the presence of non-pathogenic neutrophils lacking effector molecules and the preferential expression of iNOS and anti-inflammatory galectin-1 in regulatory cells of the innate immune system, most likely in macrophages. Intrinsic apoptosis seemed irrelevant for controlling synovial autoinflammation, but regulation through pyroptosis, mast cells and the adaptive immune system are possible alternatives.