BackgroundSpondylodiscitis is an important but not a well understood clinical part of ankylosing spondylitis (AS) or as a primary disease. Patients with spondylitis may attend to clinics mostly with back pain. Thoracic and lomber vertebrate involvement is prominent. There could be many other factors in etiology like brucellosis, tuberculosis, trauma, and malignities for non AS spondylitis (1). However there is a group of patients whom with inflammatory back pain but neither convenient with “Assessment of Spondyloarthritis International Society”(ASAS) classification criteria nor with magnetic resonance imaging (MRI) proven sacroiliitis.ObjectivesWe herein tried to compare patients with axial spondylarthritis (SpA) according to ASAS criteria and patients with signs of vertebrate involvement (spondylitis, spondylodiscitis) but without sacroiliitis.MethodsPatients with spondylitis according to ASAS/OMERACT MRI study group (2) were involved into the study. Additionally patients with inflammatory back pain and axial SpA features but without sacroiliitis both with X-ray and MRI were analyzed. We compared the demographic and clinical features, visual anologue scores (VAS) and treatments of these two groups.Results113 patients were (50 male/63 female) involved into the study. Patients without sacroiliitis were 39.7±10.4 and with sacroiliitis were 39.1±11.5 years old. Female predominancy in patients without sacroiliitis is significant (%69.8 and %38). Sacroiliitis were diagnosed with X-ray in 42 and MRI in 8 patients in sacroiliitis positive group. All the patients were using adequate dosage of non-steroidal anti inflammatory drugs [(NSAIDs), 150 mg/day diclofenac or 100-150mg/day indomethacin]. The VAS value was similar in both groups before treatment. However patients with sacroiliitis had prominent decrease in their VAS and erythrocyte sedimentation rate (ESR) opposite to sacroiliitis negative spondylitis patients. C-reaktive protein (CRP) value before treatment for sacroiliitis negative and positive spondylitis patients were 20.6±17.4 mg/dl and 22.1±20.2 mg/dl, and 12±10.1 mg/dl, 6.6±10.4 mg/dl after treatment respectively (table 1).ConclusionsInflammatory back pain is the prominent symptom also in sacroiliitis negative spondylolitic patients and it is important to classify this group in the SpA disease. The NSAID response in pure spondylitic patients was interestingly poor from sacroiliitic spondylolitis patients.ReferencesRudwalei M, van der Heijde D, Landewe R et al.: The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009; 68: 777-83.Hermann KG, Baraliakos X, van der Heijde DM, Jurik AG, Landewé R, Marzo-Ortega H, Østergaard M, Rudwaleit M, Sieper J, Braun J; Assessment in SpondyloArthritis international Society (ASAS). Descriptions of spinal MRI lesions and definition of a positive MRI of the spine in axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI study group. An...

BackgroundAntimalarials have been reported to worsen preexisting psoriasis, therefore is commonly avoided by the clinicians in the treatment of psoriatic arthritis (PsA). With the lack of any solid evidence, this precludes the potential use of hydroxychloroquine (HQ) as a part of the treatment.ObjectivesWe aimed to analyze PsA patients who are treated with HQ, identify the time on drug and reasons of discontinuation of HQ.MethodsPsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre, nationwide study in Turkey on patients with PsA. Patients are consecutively recruited to this registry, if they are diagnosed as PsA, regardless of any disease characteristics. From the registry, patients who have ever used HQ were identified including the time on HQ, whether they still continue to treatment, and the reasons of discontinuation in case of a withdrawal.ResultsUntil December 2014, 746 patients were recruited. 114 patients (15.3%) were either currently using or have been used HQ previously. 51.8% of these patients were currently using HQ (fig 1). The distribution of joint patterns were 50.9% polyarthritis, 30.7% oligoarthritis, 2.6% monoarthritis, 13.2% distal interphalangeal joint involvement, 26.3% axial disease, including patients who had combinations of different patterns. Joint patterns were not different among patients who had ever used HQ or not. The duration of HQ treatment was 41.4 (SD:38.4) months among current users vs 45.6 (SD:51.2) months in withdrawers. The reason of discontinuity could be identified in 44/55 among non-users. Within these 44 patients the most frequent reason was inefficacy (n=25) and incompliance of the patient (n=7). Retinopathy was observed in 5 patients. Liver function test abnormalities, pregnancy, hyperpigmentation of the skin, step down for being in remission and nausea were observed in 1 case each and were reported to be the reason of stopping the treatment. There were only 2 cases who had to discontinue treatment because of an increase in psoriatic lesions. One of these patients used HQ for one month and the other patient for 21 months.ConclusionsThese data show that only 2/114 patients had an increase in psoriatic lesions in PsA in a mean duration of 3.5 years due to the HQ treatment suggesting that HQ is a safe treatment choice in PsA. The efficacy and added benefits of HQ in terms of reducing cardiovascular risk factors cannot be enclosed with this registry.Disclosure of InterestNone declared

We aimed in this study to determine the changes due to hyperthyroidism or hypothyroidism in serum ferritin, iron, transferrin, vitamin B n and

BackgroundCurrently 3 sets of criteria are available for inflammatory back pain (IBP) in spondyloarthritis: Calin, Berlin and the ASAS criteria. The performances of these criterias in differentiating IBP in psoriatic arthritis (PsA) with chronic low back pain (CLBP) is currently not known.ObjectivesThe objective of this study was to assess performance of those 3 different criteria in a large multicentre PsA cohort.MethodsPsART (Psoriatic Arthritis Registry of Turkey) is a prospective, multicentre, nationwide study in Turkey on patients with PsA. Patients are consecutively recruited to this registry, if they are diagnosed as PsA, regardless of any other disease characteristics. In this registry, CLBP was defined as back pain lasting for more than 3 months. All relevant data for IBP according to Calin, Berlin and ASAS criteria for IBP were collected.ResultsPsARTcohort included 746 PsA (35.3% male) patients. Overall, 170 of 746 (22.9%) of patients had CLBP. Median PsA duration was 47 (0-538) months. Patients with CLBP were more frequently males (44.4% vs 32.5%, p=0.004), more frequently had pitting (54.5% vs 41.3%, p=0.014) and less frequently had polyarthritis (26.3% vs 51.3%, p<0.001), and DIP joint involvement (7.0% vs 13.0%, p=0.031) than without CLBP. Patients with CLBP also had lower swollen joint counts (mean (SD):1.2 (2.5) vs 1.9 (3.0), p=0.015) and higher BASDAI values (4.6 (5.6) vs 3.5 (2.4), p=0.004). The positivity of each criteria for IBP was comparable for Berlin (n=147; 86.0%) and Calin criteria (n=148; 86.5%) and was lower with the ASAS criteria (n=114; 66.7%). The agreement rate of the Berlin and Calin criteria was 88.8% whereas this was lower between ASAS and Berlin (73.5%) as well as ASAS and Calin criteria (76.5%). When divided according to gender, the agreement of ASAS criteria vs Berlin and Calin criteria was lower only in females (ASAS vs Berlin: 61.7%; ASAS ve Calin: 71.3%, Calin vs Berlin 88.3%), whereas they performed equally in males (ASAS vs Berlin: 88.2%; ASAS ve Calin: 82.9%, Calin vs Berlin 89.5%) (Table 1).Table 1.Number of patients with (+) or without (−) inflammatory back pain (IBP) according to Calin, Berlin and ASAS criteriaIBP (+)IBP (−)CalinMale724Female7618Total14822BerlinMale6610Female8113Total14723ASASMale6115Female5341Total11456ConclusionsBoth Calin and Berlin criteria seem to be effective questionaires for evaluating IBP in PsA patients with CLBP. However, ASAS criteria did not perform well particularly in female patients. For this reason, the gender distribution may be an important aspect to consider when recruting patients in clinical trials as well as guiding physicians in clinical practice.Disclosure of InterestNone declared

BackgroundIn contrast to many European countries, patients can easily admit to secondary and tertiary centers without referral by the primary care in Turkey. Therefore we also compared the management options for gout preferred in different clinical specialties.ObjectivesIn this study we investigated how gout is treated in Turkey.Methods319 consecutive patients were included in this multicenter study (mean age 58.60±12.8 years, 44 females, 272 males). All patients filled a standard questionnaire.Results53 patients were first admitted to primary care (16.6%), 101 patients to orthopedics (31.7%), 29 patients to physical therapy and rehabilitation (9.1%), 70 patients to internal medicine (21.9%), 49 patients to rheumatology departments (15.4%), and 17 patients to other clinical specialties (5.3%).Among those 313 patients admitting to health care with acute gout attack, 40 patients were referred the patient to another center without any treatment (12.8%). Referral rate remarkably higher in the primare care (%28.8).NSAIDs were the most common drugs prescribed for acute attack (60.06%), followed by colchicine (58.15). Allopurinol was given in 12.8%, and steroids in 7.99% of patients during acute attack.Regarding long term treatment, 92 patients had never been treated with allopurinol (28.8%). 29.1% (37/127) patients having less than 2 attacks per year and 28.6% (55/192) of patients having two or more attacks per year had never been treated with allopurinol (p>0.05). Only 89 patients (27.9%) were treated with allopurinol by their first physicians, and 138 patients (43.3%) were treated with allopurinol later in a different specialty. Prescription of allopurinol was more common among the rheumatologists.Diet and life style modifications were recommended in 118 of the patients (37%) by their first physicians. 171 patients (53.6%) were later recommended diet and life style modifications during their follow up in a different clinical specialty (total 289 patients, 90.6%). Diet and life style modifications were recommended more commonly in rheumatology (41 patients, 83.7%).183 (57.4%) were treated with colchicine by their first physicians, and 114 patients (35.7%) were treated with colchicine by a physician of different specialty (total 297 patients, 93.1%). Significantly more patients were treated with colchicine than with allopurinol during long term management (p<0.001).ConclusionsTreatment of gout appears suboptimal in primary care, and more than 25% of patients were referred without any treatment. Long term management also appears suboptimal in both primary care and among some specialists such as orthopedics. Only a minority of patients were recommended allopurinol and/or life style modifications by the doctors first diagnosed gout. Although long term treatment appears better among rheumatologist, still a considerable number of patients were not recommended uric acid lowering approaches in the rheumatology clinics.Disclosure of InterestNone declared