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Background:Psoriatic arthritis (PsA) is a multi-dimensional chronic disease, which can affect joints, skin and enthesis. Extrapolation of the positive treatment results of anti-tumor necrosis factor (TNF) alpha agents on spondyloarthritis and rheumatoid arthritis to the treatment practice of PsA lead to a new era for the management of PsA. However, unmet needs in the management of PsA lead to development of several drugs targeting different molecules and cytokines. The impact of these developments on PsA patients who are intolerant/unresponsive to the first biological disease-modifying anti-rheumatic drugs (bDMARD) still needs to be defined.Objectives:To explore the second biologic agent trends on PsA patients of our 10-years of single-center experience.Methods:HURBIO-PsA (Hacettepe University Rheumatology Biologic Registry) is a single center biological disease modifying anti-rheumatic drug (DMARD) registry since 2005 on PsA patients. Until the end of the 2020, 19 different rheumatologists contributed to the development of HURBIO-PsA. Anti-TNF drugs were approved as first line bDMARD for PsA patients. Distribution of the second-line biological agents (switch from first-line biological agent because of either adverse events or unresponsiveness) was calculated according to 5-year periods starting from the 2011. Also, demographic and serologic data of RA patients were reported.Results:A total of 225 PsA (225/443, 50.8%) patients, who was prescribed a second biological agent, was registered in HURBIO-PsA by the end of 2020. Of these patients, 74.7% was female. Mean age at the starting of bDMARD was 47.1 ± 11.6 years. 90 (40.0%) and 135 (60.0%) patients were prescribed with their second bDMARD in 2011-2015 and 2016-2020, respectively. There was a trend towards the increasing prescription of non-Anti-TNF bDMARDs as second-line over time, especially for secukinumab.Table 1.Distribution of second biologic DMARDs in PsA patients according to 5-years periods2011-20152016-2020TotalAdalimumab30 (33.3)33 (24.4)66 (29.3)Etanercept33 (36.7)8 (5.9)41 (18.2)Infliximab9 (10)15 (11.1)24 (10.6)Golimumab9 (10)5 (3.7)14 (6.2)Certolizumab5 (5.6)34 (25.2)39 (17.3)Anti-TNF86 (95.6)95 (70.4)181 (80.5)Secukinumab026 (19.3)26 (11.5)Ustekinumab010 (7.4)10 (4.4)Abatacept4 (4.4)2 (1.5)6 (2.6)Tofacitinib02 (1.5)2 (0.9)Non-Anti-TNF4 (4.4)40 (29.6)44 (19.5)Total90 (100)135 (100)225 (100)Approval years of drugs in Turkey; Infliximab: 2003, etanercept:2004, adalimumab: 2005, golimumab: 2013, certolizumab: 2014, secukinumab: 2018, ustekinumab: 2018; abatacept and tofacitinib were given with the permission from the Ministry of Health of Turkey for off-label use authorizationConclusion:Almost half of the PsA patients switched their anti-TNF drugs to others. Non-Anti-TNF bDMARDs, especially secukinumab, becoming more frequently used as a second-line biologic agent in PsA in recent years. These bDMARD prescription trend is appropriate to EULAR PsA recommendations.Disclosure of Interests:None declared.

BackgroundFamilial Mediterranean fever (FMF) is a periodic fever syndrome caused by MEFV mutations. FMF may be associated with psoriasis in some cases. Previous study has shown that psoriasis was more common in the relatives of FMF patients [1].ObjectivesWe aimed to investigate the prevalence of psoriasis among FMF patients and their relatives.MethodsFMF patients followed at Hacettepe University Adult and Pediatric Rheumatology Departments between January and August 2016 were consecutively enrolled to this study. Demographic data, clinical manifestations, laboratory data and MEFV variant analysis were documented by medical file screening and face-to-face interview. The presence of psoriasis and psoriatic arthritis in patients and their relatives (first [Mother, father, children]-second [Brothers, grandchildren, grandfather and grandmother]-third degree [Nephew, uncle, maternal uncle, aunt, paternal aunt] relatives) and drug use history were also questioned. The patients were accepted to have psoriasis if the diagnosis was made by a dermatologist.Results351 FMF patients (177 adults; 174 children) were included in this study (Table). 70.1% of adult patients were female, 29.9% were male. 53.4% of pediatric patients were female, 46.6% were male. The median age (min-max) of the adult patients was 35 (19–63), while the median age of the pediatric patient group was 10 (2–18). The onset age of symptom was 12 (0–39) in the adult group and 3 (1–14) in the pediatric group. The median age at diagnosis was 25 (2–52) in the adult group and 5 (1–18) in the pediatric group. Thirteen (3.7%) patients had psoriasis. Psoriasis was more common in adult patients than pediatric patients (p=0.02). Psoriasis was present in 22 (12.4%) of adult patients' and 9 (5.2%) of pediatric patients' relatives (p=0.023). The frequency of psoriasis in one or more relatives of all FMF patients was found to be 8.8%.ConclusionsIL-1 has an essential role for signaling early T helper 17 (Th17) differentiation and Ashida et al have shown the presence of Th17 cells in the upper dermis of psoriasis-like lesions in a patient with FMF [2]. We may speculate that high IL-1 in FMF may cause Th17 activation and stimulation of keratinocytes; and this may be the reason for higher frequency of psoriasis in FMF patients. Thirteen (3.7%) patients had psoriasis; more common than the normal population (0.40%) (p<0.0001). FMF increases the likelihood of psoriasis in relatives of FMF patient. Thus, FMF patients should be questioned and carefully examined for psoriasis lesions and psoriasis family history.References Barut, K., et al., Inceased frequency of psoriasis in the families of the children with familial Mediterranean fever. Clin Exp Rheumatol, 2016. 34(6 Suppl 102): p. S137.Ashida, M., et al., Psoriasis-like lesions in a patient with familial Mediterranean fever. J Dermatol, 2016. 43(3): p. 314–7. Disclosure of InterestNone declared

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