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Background:Anxiety and depression are most common psychiatric disorders in chronic inflammatory rheumatic condition as well as axial spondyloarthritis (axSpA) (1). The prevalence of depression has been reported as 11-64% depending on the criteria used. Also self-reported depression and anxiety were found to be associated with disease activity and function in axSpA (1,2). It is observed that mental health is affected among healthy subjects during the COVID-19 pandemic, but this condition has not been systematically reviewed in axSpA patients.Objectives:We aimed to compare frequency of self-reported depression and anxiety before and during the Covid-19 pandemic in patients with axSpA.Methods:Seventy-six axSpA patients who were evaluated for the presence of depression and anxiety by using Hospital Anxiety and Depression scale (HADs) before pandemic were included in this study. All participants were classified according to the ASAS axSpA classification criteria. Patients were contacted by phone to participate and complete the HADS questionnaire. Demographic and disease related characteristics including BASDAI, BASFI and Patient Acceptable Symptom State (PASS) were recorded during interview. The HADs cut off value was taken as >7 in both groups to define the presence of anxiety or depression. Before and during pandemic period anxiety and depression scores were statistically compared.Results:The demographic and disease related characteristics of axSpA patients with and without anxiety/depression were summarized in Table 1. The frequency of anxiety (43.4% vs %43.4; p>0.05) and depression (46.1% vs 44.7%; p>0.05) were found to be similar before and during pandemic period. Patients with anxiety (HADs>7) and depression (HADs>7) had higher BASDAI and BASFI scores and much less PASS positivity (Table 1). Although the frequency of depression was similar between before and during the pandemic period, symptom severity in depression was slightly increased during the pandemic (Figure 1).Table 1.Patients’ demographics and characteristics according to the presence of anxiety and depressionVariablesPresence of depressionn:35Absence of depressionn:41PPresence of anxiety n:33Absence of anxiety n:43PAge (years) mean ± SD41.8±11.244.1±9.3>0.0542.0±10.943.6±10.0>0.05Male n(%)21(60.0)26(63.4)>0.0518(54.5)29(67.4)>0.05Education time (years) mean ± SD9.6±4.811.0±4.2>0.059.7±5.010.6±4.1>0.05Current smoker n(%)18(51.4)15(36.6)>0.0515(45.5)18(41.9)>0.05Alcohol consumption n(%)12(34.3)12(29.3)>0.0510(30.3)14(32.6)>0.05Current BMI kg/m2 mean ± SD26.0±4.826.8±4.5>0.0526.4±5.026.5±4.3>0.05Sleep time (hours) mean ± SD7.6±1.77.6±1.3>0.057.5±1.67.7±1.4>0.05Current BASDAI mean ± SD2.5±1.61.4±1.6<0.052.7±1.81.3±1.3<0.001Current BASFI mean ± SD2.4±2.11.1±1.3<0.052.4±2.01.2±1.4<0.05PASS positivity n(%)16(45.7)29(70.7)<0.0514(42.4)31(72.1)<0.05Current depression and anxiety scores were correlated with disease activity (HADs Depression vs BASDAI r:0.530, p<0.001; HADs Anxiety vs BASDAI r:0.500, p<0.001) and function (HADs-Depression vs BASFI r:0.519, p<0.001; HADs-Anxiety vs BASFI r:0.391, p<0.001). These relationships were also observed in the pre-pandemic period (HADs-Depression vs BASFI r:0.326, p<0.05; HADs-Anxiety vs BASDAI r:0.342, p<0.05).Conclusion:Depression and anxiety symptoms seems to be comparable before and after the COVID-19 pandemic. Regardless of this period, the presence of both depression and anxiety are associated with disease activity, function and less patient acceptable symptom state.References:[1]Zhao S, Thong D, Miller N, et al. The prevalence of depression in axial spondyloarthritis and its association with disease activity: a systematic review and meta-analysis. Arthritis Res Ther. 2018;20:140.[2]Barişan E, Bayir D, Solmaz D. Aksiyel spondiloartrit hastalarinda anksiyete düzeyinin çeşitli ölçeklerle değerlendirilmesi ve anksiyete ile ilişkili faktörler. Dokuz Eylül Üniversitesi Tip Fakültesi Dergisi. 2019; 129-137.Figure 1.Disclosure of Interests:None declared

Background:On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) as a pandemic, and mandatory quarantine was applied in Turkey between April and June 2020. With this sanction, sudden changes occurred in a routine lifestyle.Objectives:This study aimed at evaluating physical activity changes, presence of anxiety and depression, altered eating habits and their relationship with disease activity in axial spondyloarthritis (AxSpA) patients during the quarantine period.Methods:AxSpA patients, who were examined in the rheumatology clinic in the last year before the pandemic period and their relatives were included in this study and were contacted by phone to participate. A structured questionnaire form was performed which included the following data: questions about demographic characteristics, medication use, disease activity scales; BASDAI, BASFI, Patient acceptable symptom state (PASS), patient-reported physical activity state, Short Questionnaire to Assess Health enhancing physical activity (SQUASH), Three-Factor Eating Questionnaire (TFEQ-21), and Hospital Anxiety and Depression Scale (HADs).Results:204 AxSpA patients and 106 patients’ relatives were contacted in the study (Figure 1). The frequency of male sex and alcohol consumption was higher in the AxSpA compared to the relatives and, other demographic features were summarized in Table 1. 30% of AxSpA patients and 37% of patient relatives were gained weight with mean 4.5±2.4 and 4.4±3.4 kilograms, respectively. Weight gain were similar male and female in AxSpA (26.2% vs 37.2%, p>0.05). However, the men in the AxSpA group gained more weight than relatives group (26.2% vs 7%, p<0.05). Weight gain group had decreased physical activity than stable group in AxSpA patients (54.8% vs 37.8%, p<0.05). We showed mild negative correlation between BASDAI and BASFI scores with SQUASH- total activity score (r:-0.15, p<0.05; r:-0.25, p<0.001, respectively). Anxiety prevalence were found slightly higher in patients group but not significantly (40.2% vs 32.1%; p>0.05). Depression were much higher in AxSpA group than relatives (43.6% vs 28%, p<0.001). Depression and anxiety were correlated with disease activity (HADs Depression vs BASDAI r:0.380, p<0.001; HADs Anxiety vs BASDAI r:0.418, p<0.001) and function (HADs Depression vs BASFI r:0.342, p<0.001; HADs Anxiety vs BASFI r:0.313, p<0.001). Among eating habits, uncontrolled and emotional eating scores were showed low correlation with anxiety (r:0.169, p<0.05; r:0.163, p<0.05, respectively).Conclusion:One third of our patients were weight gain and approximately half of them had decreased physical activity but we did not show relation between these parameters and disease related factors in the limited period. In addition to that depression and anxiety were detected significant part of AxSpA patients and both of them were correlated with disease activity.Table 1.Study Population CharacteristicsAxSpa n:204 Controls n:106 p valueAge (years) mean ± SD43.1±11.440.6±12.6>0.05Male n(%)125(61.3)26(24.5)<0.001Education time (years) mean ± SD9.8±4.39.7±4.0>0.05Current smoker n(%)77(37.7)31(29.2)>0.05Alcohol consumption n(%)60(29.4)9(8.5)<0.001Current BMI kg/m2 mean ± SD26.8±4.626.5±4.7>0.05Weight gain group n(%)62 (30.4)40(37.7)>0.05Weight stable group n(%)142 (69.6)66(62.3)Current BASDAI mean ± SD1.8±1.5N/ACurrent BASFI mean ± SD1.5±1.8N/APatients treated with biologic drugs n(%)118(57.8)N/APatients treated with conventional drugs n(%)84(41.1)N/APresence of Anxiety n(%)82(40.2)34(32.1)>0.05Presence of Depression n(%)89(43.6)30(28.0)<0.001TFEQ-R21emotional eating mean ± SD5.2±3.15.6±2.7<0.05TFEQ-R21uncontrolled eating mean ± SD14.7±6.317.5±5.4<0.001TFEQ-R21cognitive restraint mean ± SD14.3±4.315±4.2>0.05Stable physical activity n(%)117(57.4)49(46.2)>0.05Decreased physical activity n(%)87(42.6)57(53.8)Acknowledgements:Special thanks to our clinical nurse Alev Vayni for her devoted assistance in interviewing patients to fill out the questionaire.Disclosure of Interests:None declared.

Background:Non-steroidal anti-inflammatory drugs (NSAIDs) is the first line treatment option in axial spondyloarthritis (axSpA) patients suffering from pain and stiffness. However there is only limited data regarding the concomitant use of NSAIDs during tumour necrosis factor inhibitor (TNFi) treatment.Objectives:To evaluate longitudinal concomitant NSAIDs use with the TNFi treatment and the determinant of the ASAS-NSAID index in patients with axSpA.Methods:In total 429 axSpA patients (253 [59%] male; 272 [63%] with AS and 157 [37%] with non-radiographic (nr)-axSpA) who have followed up one year were included in this observational study. The data regarding disease activity and serum CRP levels were collected on 12, 24 and 52nd week. At each visit NSAID usage, type, dosage and frequency were recorded in order to calculate ASAS-NSAID index. The longitudinal relationship between NSAID-index and other factors tested by using generalized estimating equations (GEE) which is a technique for longitudinal data analysis allowing the use of all available data even deviated from normality.Results:At baseline 127/138 (92%) patients starting TNFi and 239/291 (82%) conventionally treated patients were using NSAID. Both the rate (p=0.007) and the median (IQR) ASAS-NSAID index were higher in biologic treatment group (100 [50] vs 70.8 [89.4]; p<0.001). During follow-up ASAS-NSAID index was decreased significantly in patients treated with TNFi (median 100 to 8.0;p<0.001), however ASAS-NSAID index was not changed in conventionally treated patients (p=0.154) (Figure 1). In univariate longitudinal analysis revealed that ASAS-NSAID index was significantly associated with BASDAI, ASDAS, BASFI scores and patient global assessment of disease activity, serum levels of CRP and education. We established two multivariable models (Table 1) to assess the associated factors/covariates with ASAS-NSAID index over time (one with ASDAS and the other BASDAI+CRP as disease activity index) and showed that BASDAI and patient global assessment of disease activity were independent determinants of NSAID dosage in biologic treated patients. However, in multivariate analysis there was no significant predictor for NSAID index in conventional treatment group.Conclusion:Our results showed that NSAID prescription was significantly higher in axSpA patients who have TNFi indication. NSAID use was decreased significantly over time with TNFi and still independently determined by disease activity. However, it is stable in conventionally treated axSpA patients.Table 1.The factors associated with ASAS-NSAII index in biologic treated patientsModel 1Model 2B95%CIpB95% CIpBASFI-0.55-4.384; 4.2750.9800.943-3.795; 5.6820.696BASMI0.951-1.511; 3.4130.449-0.098-2.430; 2.2340.934PGA0.5350.210; 0.8600.0010.7590.432; 1.0860.000CRP-0.068-0.220; 0.0840.380BASDAI5.7182.487; 8.9490.001ASDAS-CRP1.771-6.571; 10.1130.677PGA:Patient global assessmentDisclosure of Interests:None declared

ObjectiveTo investigate macro-scale estimators of the variations in COVID-19 cases and deaths among countries.DesignEpidemiological study.SettingCountry-based data from publicly available online databases of international organisations.ParticipantsThe study involved 170 countries/territories, each of which had complete COVID-19 and tuberculosis data, as well as specific health-related estimators (obesity, hypertension, diabetes and hypercholesterolaemia).Primary and secondary outcome measuresThe worldwide heterogeneity of the total number of COVID-19 cases and deaths per million on 31 December 2020 was analysed by 17 macro-scale estimators around the health-related, socioeconomic, climatic and political factors. In 139 of 170 nations, the best subsets regression was used to investigate all potential models of COVID-19 variations among countries. A multiple linear regression analysis was conducted to explore the predictive capacity of these variables. The same analysis was applied to the number of deaths per hundred thousand due to tuberculosis, a quite different infectious disease, to validate and control the differences with the proposed models for COVID-19.ResultsIn the model for the COVID-19 cases (R2=0.45), obesity (β=0.460), hypertension (β=0.214), sunshine (β=−0.157) and transparency (β=0.147); whereas in the model for COVID-19 deaths (R2=0.41), obesity (β=0.279), hypertension (β=0.285), alcohol consumption (β=0.173) and urbanisation (β=0.204) were significant factors (p<0.05). Unlike COVID-19, the tuberculosis model contained significant indicators like obesity, undernourishment, air pollution, age, schooling, democracy and Gini Inequality Index.ConclusionsThis study recommends the new predictors explaining the global variability of COVID-19. Thus, it might assist policymakers in developing health policies and social strategies to deal with COVID-19.Trial registration numberClinicalTrials.gov Registry (NCT04486508).