Journal Article Macrophage activation syndrome triggered by cytomegalovirus in a patient with granulomatosis with polyangiitis Get access Bengisu Aslan, Bengisu Aslan Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Funda Erbasan, Funda Erbasan Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey Correspondence to: Funda Erbasan, Akdeniz University Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, 07070, Antalya, Turkey. E-mail: fundaerb@yahoo.com https://orcid.org/0000-0001-9960-5664 Search for other works by this author on: Oxford Academic PubMed Google Scholar Tahir Saygın Öğüt, Tahir Saygın Öğüt Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Melis Dilbil, Melis Dilbil Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Veli Yazısız, Veli Yazısız Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Ender Terzioğlu Ender Terzioğlu Department of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine, Antalya, Turkey Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume 61, Issue 3, March 2022, Pages e72–e74, https://doi.org/10.1093/rheumatology/keab778 Published: 22 October 2021 Article history Received: 16 July 2021 Revision received: 07 September 2021 Accepted: 28 September 2021 Published: 22 October 2021 Corrected and typeset: 26 October 2021

Cervical carcinoma is significantly associated with the human papillomavirus (HPV). Persistent infection with high risk-HPV is necessary but not sufficient for the development of cervical cancer. It is not fully understood which immunological mechanisms lead to persistence in some patients. During the life cycle, HPV uses excellent immune evasion mechanisms. Keratinocytes, Langerhans cells (LC), dendritic cells (DC), tissue-resident macrophages, and intraepithelial gamma-delta T cells (γδ T cells) are cellular components of the mucosal immune defense of the female genital tract against HPV. γδ T cells, the prototype of unconventional T cells, play a major role in the first line defense of epithelial barrier protection. γδ T cells connect the innate and adaptive immunity and behave like a guardian of the epithelium against any form of damage such as trauma and infection. Any changes in γδ T cell distribution and functional capability may have a role in persistent HPV infection and cervical carcinogenesis in the early phase. Poor stimulation and maturation of APCs (LC/DC) might lead to persistent HPV infection which all point out pivotal role of γδ T cells in HPV persistence. If such an intriguing link is proven, γδ T cells can be used in potential therapeutics against HPV in infected patients.

Seronegatif spondiloartrit; genetik olarak yatkın kişilerde kronik enflamasyonla ortaya çıkan benzer patogenezlere sahip bir hastalık grubudur.Bu hastalık grubunun prototipi aksiyel iskelet sistemini tutan ankilozan spondilittir

Background: Articular manifestations may differ in ulcerative colitis (UC) and Crohn’s disease (CD). Genetic and non-genetic factors like sex, smoking, and presence of HLA-B27 were previously shown to modify the expression of articular and other extraintestinal manifestations of IBD. Objectives: The aim of this study is to document disease features and factors affecting the expression of articular manifestations in Turkish patients with IBD-related (enteropathic) arthritis under treatment with disease modifying antirheumatic drugs (DMARDs). Methods: Data regarding enteropathic arthritis (EA) were collected from the TReasure database, a nation-wide multicenter observational registry of inflammatory arthritis patients. Results: Among 4066 patients with seronegative spondyloarthropaties (SpA), 156 (3.8%) had EA, not reflecting a true prevalence due to selection bias. Demographic and clinical features according to IBD groups were summarized in Table 1. Rates of presence of sacroiliitis were similar between patients with UC and CD (39.9% and 60.1%, p=0.086 respectively). Rates of HLA-B27 positivity were 31.6% and 7.1% in patients with and without radiographic sacroiliitis, respectively (p=0.101). Enthesitis, dactylitis, psoriasis, family history forSpA, ESR, CRP, BASDAI and aSDAS levels had similar distributions in patients with and without radiographic sacroiliitis. Rates of “never-smoked” (26.5% vs 64.7%) and “current smoking” (32.4% vs 17.6%) significantly differed in patients with and without sacroiliitis (overall p=0.012) Conclusion: Our data confirm an association between smoking status and disease manifestations, particularly radiographic sacroiliitis. References [1] Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol2009; 15: 2449-2455. Disclosure of interests: Orhan Küçükşahin: None declared, abdulsamet Erden: None declared, Ufuk İlgen: None declared, Sedat Kiraz: None declared, ali İhsan Ertenli: None declared, Nazife Sule Yasar Bilge: None declared, Timuçin Kaşifoğlu: None declared, Ediz Dalkılıç Grant/research support from: MSD and abbvie, Consultant for: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilüfer alpay Kanıtez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, abbvie,Celltrion, Novartis, Pamir atagündüz: None declared, Belkis Nihan Seniz: None declared, Burcu Yağız: None declared, Süleyman Serdar Koca: None declared, Muhammet Çınar: None declared, aşkın ateş: None declared, Servet akar Grant/research support from: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Speakers bureau: Pfizer, Önay Gerçik: None declared, Duygu Ersözlü: None declared, Veli yazısız: None declared, Gezmiş Kimyon: None declared, Müge aydın: None declared, Rıdvan Mercan: None declared, Burak Öz: None declared, Zeynel abidin akar: None declared, Omer Karadag: None declared, Bahar Keleşoğlu: None declared, Sedat Yılmaz: None declared, Yavuz Pehlivan: None declared, Ender Terzioğlu: None declared, Levent Kılıç: None declared, Sukran Erten: None declared, Koray Taşçılar: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer and abdi Ibrahim, Speakers bureau: MSD, abbvie, Roche, UCB, Novartis, Pfizer and abdi Ibrahim

Background:Uveitis is the most common extra-articular feature of spondyloarthritis (SpA). Sometimes uveitis may be the only clinical finding of SpA leading to diagnosis. In the current literature, there is information about frequency and characteristics of uveitis in SpA patients; however, factors associated with uveitis are not clear(1,2).Objectives:Our aim in this study was to analyze uveitis-related factors in a large cohort of SpA patients.Methods:This multicenter, prospective observational cohort study used the TReasure database in which web-based registration of rheumatoid arthritis and SpA patients are being performed in 15 centers across different regions of Turkey. Age, gender, duration of illness, delayed onset, SpA clinical findings, HLA B27 and acute phase responses (erythrocyte sedimentation rate and C-reactive protein, BASDAI and BASFI values, clinical findings and direct X-ray findings of SpA patients with and without uveitis were retrospectively evaluated.Results:As of January 2019, there were 4557 registered SpA patients. Overall, 491 (10.8%) patients had experienced one or more episodes of uveitis. The median (Q1-Q3) uveitis onset age was 46 years (38-53 years) and the median (Q1-Q3) uveitis attack number was 2 (1-4). Uveitis was usually unilateral (74.2%). Records of eye damage was available in 373 patients, of whom 45 (12.1%) had permanent damage in the eye. Patients with permanent eye damage had more frequent uveitis attack (3 (2-6) vs. 2 (1-3), p=0.003) and had tendency of bilateral uveitis attack (41.5% vs 24%, p=0.017). Duration between the first uveitis attack and onset of SpA symptoms was 68 months (7-141). On the other hand, the mean duration between the first uveitis attack and SpA diagnosis is 7 months (17-68 months). In 320 patients (70%), uveitis was diagnosed before the onset of SpA symptoms and 52% (n=240) of the patients had uveitis before SpA diagnosis. Demographic and clinical features of the patients are given in Table 1.Conclusion:In our cohort, genetic background, radiographic severity, and disease duration may be related with uveitis. HLA B27 positivity and family history may be risk factors for development of uveitis. First attack of uveitis is nearly always before the onset of symptoms and diagnosis of SpA. Although uveitis is usually self-limited; however, almost 10% of SpA patients may have permanent eye damage. Thus, patients with uveitis should be carefully investigated because it may be the diagnostic feature of SpA.Disclosure of Interests: :Nazife Sule Yasar Bilge: None declared, Timuçin Kaşifoğlu: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Orhan Küçükşahin: None declared, Ediz Dalkılıç Grant/research support from: MSD and Abbvie, Consultant for: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilüfer Alpay Kanıtez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, Abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, Abbvie,Celltrion, Novartis, Pamir Atagunduz: None declared, Belkis Nihan Seniz: None declared, Burcu Yağız: None declared, Süleyman Serdar Koca: None declared, Muhammet Çınar: None declared, Aşkın ATEŞ: None declared, Servet Akar: None declared, Duygu Ersözlü: None declared, Veli Yazisiz: None declared, Gezmiş Kimyon: None declared, Muge Aydın Tufan: None declared, Ridvan Mercan: None declared, Abdulsamet Erden: None declared, Erdal Bodakci: None declared, Önay Gerçik: None declared, Burak Öz: None declared, Zeynel Abidin Akar: None declared, Omer Karadag: None declared, Bahar Dincer: None declared, Sedat Yılmaz: None declared, Yavuz Pehlivan: None declared, Ender Terzioğlu: None declared, Levent Kılıç: None declared, Emel Gönüllü: None declared, Sukran Erten: None declared, Sezin Turan: None declared, Koray Taşçılar: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim

Background: In rheumatoid arthritis (RA), biologic DMARDs are important treatment options in resistant patients. Inefficacy or side effects may cause switching between these drugs. Objectives: This study aimed to determine features of patients switching from one biologic DMARD to another in RA treatment and to investigate associated reasons for switching. Methods: This multicenter, prospective observational cohort study used the TReasure database in which web-based registration of RA and spondyloarthritis patients are being performed in 15 centers across different regions of Turkey. In this study, data of RA patients switching from one biologic agent to another were analyzed. Demographic and clinical data, follow-up duration, time to switch, and reasons for switching were retrieved from the database. Results: Of the included 2115 RA patients, 829 (39.2%) switched between biologic agents (switched group) and 1286 (60.8%) continued to receive their current therapies (continued group). The median follow-up duration of all patients was 3.7 years and the median time to switch was 1.1 years. In the switched group, the proportion of females and the median HAQ-DI score were higher as well as disease duration was longer (Table 1). Among the biologic agents used at first, 60.9% of the patients were receiving an anti-TNF agent and 39.1% of the patients were receiving other biologic agents (Table 2, figure 1). In the switched group (n=829), the main reasons for switching were secondary inefficacy (n=269), primary inefficacy (n=238), and side effects (n=178) followed by primary or secondary unknown inefficacy (n=30), patient's demand (n=21), physician's request (n=16), willing to be pregnant (n=7), other (n=31), and unknown (n=54). Conclusion: The patients in the Treasure database were followed-up approximately 4 years and about one-third of the patients had to switch from one biologic DMARD to another. The main reasons for this switching were primary (29.2%) and secondary (33.0%) inefficacy and 20% of the patients had to switch due to side effects. According to the switching pattern, about half of the patients using an anti-TNF agent at first switched to another anti-TNF agent and the other half switched to other biologic agents. Disclosure of Interests: Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Ali İhsan Ertenli: None declared, Abdulsamet Erden: None declared, Orhan Küçükşahin: None declared, Timuçin Kaşifoğlu: None declared, Ediz Dalkılıç Grant/research support from: MSD and Abbvie, Consultant for: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilüfer Alpay Kanıtez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, Abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, Abbvie,Celltrion, Novartis, Pamir Atagündüz: None declared, Belkıs Nihan Coşkun: None declared, Burcu Yağız: None declared, Süleyman Serdar Koca: None declared, Muhammet Çınar: None declared, Aşkın Ateş: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersözlü: None declared, Veli Yazısız: None declared, Gezmiş Kimyon: None declared, Müge Aydın: None declared, Rıdvan Mercan: None declared, Burak Öz: None declared, Nazife Sule Yasar Bilge: None declared, Zeynel Abidin Akar: None declared, Omer Karadag: None declared, Ayse Bahar Kelesoglu Dincer: None declared, Sedat Yilmaz: None declared, Ufuk İlgen: None declared, Yavuz Pehlivan: None declared, Ender Terzioğlu: None declared, Levent Kılıç: None declared, Şükran Erten: None declared, Sedat Kiraz: None declared

Objective: This study aims to investigate the changes in professional values through a structured training program and standardized patient practices. Method: The study was conducted with 346 3rd year medical students during the 2016-2017 academic year. Attitudes towards professionalism were assessed by using the “Professionalism” scale developed by The Penn State College of Medicine. The scale was applied to all of the students before the training (pretest) and after the training was completed (post-test). Results: The mean scores of the pre-test and post-test, respectively, were 17.5±1.8-18.1±1.9 for accountability; 16.34±2.117.0±1.6 for enrichment; 12.5±1.3-13.0±2.1 for equity; 19.6±1.720.7±1.5 for honor and integrity; 8.4±1.2-13.5±2.1 for altruism; 11.9±1.2-13.4±1.1 for duty; and 5.51±0.6-5.92±0.9 for respect (p<0.05). When the mean scores of the students were compared based on gender, the scores of the female students were found to be higher than those of the male students in all sub dimensions (p<0.05). Conclusion: Professional values are important concepts which are complex, difficult-to-measure and affected by multiple factors. An increase was observed in the professionalism scores of the students after the standard patient education practice. This increase was found to be significantly higher among the female students than among the male students.

Objective: This study aims to investigate the changes in professional values through a structured training program and standardized patient practices. Method: The study was conducted with 346 3rd year medical students during the 2016-2017 academic year. Attitudes towards professionalism were assessed by using the "Professionalism" scale developed by The Penn State College of Medicine. The scale was applied to all of the students before the training (pretest) and after the training was completed (post-test). Results: The mean scores of the pre-test and post-test, respectively, were 17.5 +/- 1.8-18.1 +/- 1.9 for accountability; 16.34 +/- 2. 117.0 +/- 1.6 for enrichment; 12.5 +/- 1.3-13.0 +/- 2.1 for equity; 19.6 +/- 1.7- 20.7 +/- 1.5 for honor and integrity; 8.4 +/- 1.2-13.5 +/- 2.1 for altruism; 11.9 +/- 12-13.4 +/- 1.1 for duty; and 5.51 +/- 0.6-5.92 +/- 0.9 for respect (p<0.05). When the mean scores of the students were compared based on gender, the scores of the female students were found to be higher than those of the male students in all sub dimensions (p<0.05). Conclusion: Professional values are important concepts which are complex, difficult-to-measure and affected by multiple factors. An increase was observed in the professionalism scores of the students after the standard patient education practice. This increase was found to be significantly higher among the female students than among the male students.

Background: switching from reference infliximab (RI) to biosimilar infliximab (BI) had no detrimental effects on efficacy and safety compared to continuous RI.However, long-term follow-up data is missing.Objectives: the aim of this study was to evaluate if BI is equivalent to RI to maintain patients with Ankylosing Spondylitis (AS) in clinical remission, in a long-term fashion.Methods: one hundred and nine consecutive unselected AS patients were investigated.All, followed-up at predefined times receiving RI (5mg/kg/8 weeks) and were naïve to other biologics.Patients who were in clinical remission were asked to switch from RI to BI using the same therapeutic dose.Patients switched to BI were compared with a match control group receiving continuous RI.During follow-up the demographic, clinical, laboratory parameters and comorbidities were all recorded for at least 18 months.Disease activity was measured using the Bath Ankylosing Spondylitis activity index (BASDAI), and the Ankylosing Spondylitis disease activity score (ASDAS), using the C-reactive protein.Remission was defined if patients achieved BASDAI <4 and ASDAS <1.3.Results: twenty-one patients were excluded, nine because had no clinical remission and twelve because refused to switch.Thus, 88 were evaluated.From those, 45 switched to BI, while 43 continued receiving RI.There were no differences between groups regarding demographic, clinical and laboratory parameters.All patients were in clinical remission (BASDAI <4 and ASDAS <1.3).During follow-up, five patients from the switched group and three from the maintenance group discontinued the study.Four patients receiving BI presented nocebo effects and were switched back to the RI.Three responded well, while the fourth did not.After 18 months of treatment, all patients in both groups remained in clinical remission.No significant adverse events were noted between groups.Conclusion: BI is equivalent to RI in maintaining AS in clinical remission for at least 18 months.

Background/aim: The TReasure registry, created in 2017, is an observational multicenter cohort that includes inflammatory arthritis patients. This article reviews the methodology and objectives of the TReasure registry established to collect data from rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients. Methodology: Fifteen rheumatology centers in Turkey will contribute data to the TReasure database. The actual proprietor of the database is the Hacettepe Rheumatology Association (HRD) and Hacettepe Financial Enterprises. Pharmaceutical companies that operate in Turkey (in alphabetical or er), Abbvie, Amgen, BMS, Celltrion Healthcare, Novartis, Pfizer, Roche, and UCB, support the TReasure registry. TReasure is a web-based database to which users connect through a URL (https://www.trials-network.org/treasure) with their unique identifier and passwords provided for data entry and access. TReasure records demographic and clinical features, comorbidities, radiology and laboratory results, measures of disease activity, and treatment data. Discussion: TReasure will provide us with various types of data, such as a cross-sectional view of the current nationwide status of the patients currently receiving these treatments, and retrospective data as much as allowed by the participating centers' records. Finally, a high-quality prospective dataset will be built over the ensuing years from patients with a new diagnosis of RA or SpA.

Objective: The purpose of this study was to investigate the plasma soluble tumour necrosis factor related apoptosis-inducing ligand (sTRAIL) level in rheumatoid arthritis (RA) and to evaluate the relationship between sTRAIL and disease activity. Material and Methods: 19 RA patients, and as a control group 31 primary Sjogren’s syndrome (pSS) patients and 24 healthy subjects were included in the study. Disease activity of RA patients was calculated by the Disease Activity Score-28 (DAS-28). Plasma sTRAIL concentrations were measured by the enzyme linked immunosorbent assay (ELISA). Results: Mean plasma sTRAIL concentration in RA patients (1751 ± 635 pg/ml) was higher than in disease control patients with pSS (1234 ± 625 pg/ml) and in healthy controls (1181 ± 304 pg/ ml) (p=0.002). In RA patients, there was no correlation between mean DAS-28 score and plasma sTRAIL levels. And also, there was no correlation between sTRAIL levels and laboratory parameters indicating disease activity such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). conclusion: Plasma sTRAIL levels were significantly higher in RA regardless of disease activity. These findings suggest that sTRAIL may have an important role in the pathogenesis of rheumatoid arthritis.

Background The pathogenesis of ankylosing spondylitis (AS) has strongly been associated with the gene HLA-B27; however, AS occur only in 1%–5% of HLA-B27-positive individuals and increasing evidence suggests involvement of also non-HLA genes. Previous work has confirmed association with single nucleotide polymorphisms in interleukin-23 receptor (IL-23R). Objectives The aim of the study is to confirm the association of IL-23R gene polymorphisms with ankylosing spondylitis in Turkish population and to find out possible mutations responsible from this association. Methods We included 48 AS patients and 48 healthy unrelated individuals. Extracted DNA from patient specimens was amplified with polymerase chain reaction and sequenced. Results We identified 6 new point mutations at IL-23R gene in patients with AS (Table). 2824DelC mutation (1/41 - 2,4%) was found to be in the intronic region that probably does not have an effect on the protein. 34521GT mutation (1/36 - 3,8%) was located at the exon-intron boundary and changes the exon recognition site. This should be the reason for exon skipping. The mutation probably changes the protein structure and function of IL-23R protein. Ala228Ala (2/42 - 4,8% - p.0,0306) was a silent mutation that does not change the protein structure of the IL23R protein. Ala364Gly mutation (6/43–17% - p.0,074) missense mutation was found at 6 patients as a heterozygote. Ala364Gly mutation looks associated with AS. Leu371Phe mutation (1/43 - 2,3%) was also missense mutation and caused change on the aminoacid. As the last point, Tyr436Stop is a silent mutation that is an early stop truncating the protein 194 aminoacid earlier than the usual process. Conclusions We have determined 6 new point mutations in 11 patients included. Although two of the mutations probably do not have an effect on the protein, other four mutations cause changes in the protein structure of IL-23R protein. We consider that these mutations probably contribute to the pathogenesis of AS by effecting the functions of the protein. References Brionez TF, Reveille JD. The contribution of genes outside the major histocompatibility complex to susceptibility to ankylosing spondylitis. Curr Opin Rheumatol. 2008 Jul;20(4): 384–91. Karaderi T, Harvey D, Farrar C, et al. Association between the interleukin 23 receptor and ankylosing spondylitis is confirmed by a new UK case-control study and meta-analysis of published series. Rheumatology (Oxford). 2009 Apr;48(4):386–9. Disclosure of Interest None declared

ObjectiveTo estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients.MethodsIn this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs.ResultsThe study included 689 RA patients (565 females) with a mean age of 51.2 +/- 13.2 years and mean disease duration of 9.4 +/- 7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire Disability Index (5.08 +/- 2.34 and 1.08 +/- 0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7 +/- 9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was 4,954 (median, 1,805), whereas the mean annual indirect cost was 2,802 (median, 608). Pharmacy costs accounted for the highest expenditure (mean, 2,777; median, 791), followed by the RA-related consultations and expenses (mean, 1,600; median, 696).ConclusionRA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

Background Primary Sjögren9s syndrome (pSS) is a systemic autoimmune disease with unknown aetiology and involves mainly salivary and lacrimal glands. It is an autoimmune disease with a broad range of systemic manifestations. Mortality rate might reduce in pSS patients with treated new medications. There is no information on survival of pSS patients in our country. Objectives This study was conducted to determine clinical features and survival in pSS patients Methods All pSS patients who diagnosed betwen 2004–2014 years were included in this study. The clinical and laboratory features and mortality rates were reevaluated Results There were 718 patients with suspected pSS at 10 years. 372 patients were classified as pSS according to 2012 American Collage of Rheumatology Classification Criteria for Sjögren9s Syndrome. Women/men ratio was 11/1. The mean age at the time of diagnosis was 50.3±11.81 years. 14 patients (3.8%) were diagnosed different malignancy and 18 patients died (4.8%). The rate of 10-year survival was 95.6% (%96.6 for women, %86.6 for men, p:0.004). 10-year survival rate was % 98.7 in patients without pulmonary involvement, but 79.2% in patients with pulmonary involvement. Multivariate Cox analysis showed that pulmonary involvement (OR:12.8, %95 CI: 4.52–44.8, p<0.001) and male gender (OR:1.7%95, CI: 1.17–4.53, p=0.004) were independent mortality risk factors Conclusions Our data revealed that cumulative survival was 95.6% at 10 years in pSS patients. Pulmonary involvement represented the main cause of death. pSS patients with pulmoner involvement have greater risk of death. Disclosure of Interest None declared

Background Interstitial lung diseases (ILDs) may occur secondary to connective tissue diseases (CTDs) and increase morbidity and mortality due to ventilation impairment. Objectives To reveal clinical, laboratory and imaging features of CTD -ILDs and to analyze treatment approaches. Methods One hundred thirty two consecutive patients were included in this cohort. Demographic characteristics, laboratory and HRCT results and treatment results were analyzed. More than 10% increase of pulmonary function tests were categorized as improvement, >10% decrease were categorized as deterioration and ±10% changes were categorized as stable disease. Results There were 111 ILD patients (86.5% CTD-ILD) with follow-up time for more than 6 months. Median follow up time was 48 (Min-Max:6–260) months and mean age was 54.5±11.9 years. HRCT scan was repeated in median 3 (1–10) times per patients, with median 12.5 month intervals. The most frequent HRCT findings were ground-glass opacities, interlobular septal thickening and honeycomb patterns. 89.6% of CTD-ILD patients recieved corticosteroids and 44.8% recieved hydroxylchloroquine sulphate. Azathioprine and cyclophosphamide were the most common used immunosupresive drugs. Eighty four patients recieved at least one immunosuppressive agent. There were only 2 patients treated with four different immunosuppressive drugs. After treatment, mean pulmonary function tests did not significanty differ from baseline (p>0.05) (Table). 35% of the patients improved forced vital capacity(FVC >%10 increase) by treatment whereas 31% had decreased and 34% were stable. Conclusions It is not detected to have significant improvement by current immunosuppressive drugs in patients with CTD-ILDs. There is need more effective novel drugs to treat for CTD-ILD. Disclosure of Interest None declared