ERAP1 association is present only in HLA-B*27+ patients, but other genetic associations are similar between the two groups. A genetic study supports the existence of an HLA-B27-independent common link between gut inflammation and AS. It is unusual to observe familial occurrence of primary AS among families of northern European extraction that show no segregation of HLA-B*27, psoriasis, or IBD. Although there are many similarities among AS patients possessing HLA-B*27 versus those lacking this gene, the former group has a younger age of onset, a shorter delay in diagnosis, a better clinical response to tumor necrosis factor inhibitors, a greater familial occurrence, a greater risk for occurrence of acute anterior uveitis, and a lower risk for occurrence of psoriasis and IBD. ERAP1 association is present only in HLA-B*27+ patients, but other genetic associations are similar between the two groups. It is unusual to observe occurrence of primary AS among families of northern European extraction that show no segregation of HLA-B*27, IBD, or psoriasis. A recent genetic study supports the existence of an HLA-B*27-independent common link between gut inflammation and AS.

Ankylosing spondylitis (AS) is a highly heritable immune-mediated arthritis common in Turkish and Iranian populations. Familial Mediterranean Fever (FMF) is an autosomal recessive autoinflammatory disease most common in people of Mediterranean origin. MEFV , an FMF-associated gene, is also a candidate gene for AS. We aimed to identify AS susceptibility loci and also examine the association between MEFV and AS in Turkish and Iranian cohorts. We performed genome-wide association studies in 1001 Turkish AS patients and 1011 Turkish controls, and 479 Iranian AS patients and 830 Iranian controls. Serum IL-1β, IL-17 and IL-23 cytokine levels were quantified in Turkish samples. An association of major effect was observed with a novel rare coding variant in MEFV in the Turkish cohort (rs61752717, M694V, OR = 5.3, P = 7.63×10 −12 ), Iranian cohort (OR = 2.9, P = 0.042), and combined dataset (OR = 5.1, P = 1.65×10 −13 ). 99.6% of Turkish AS cases, and 96% of those carrying MEFV rs61752717 variants, did not have FMF. In Turkish subjects, the association of rs61752717 was particularly strong in HLA-B27 -negative cases (OR = 7.8, P = 8.93×10 −15 ), but also positive in HLA-B27 -positive cases (OR = 4.3, P = 7.69×10 −8 ). Serum IL-1β, IL-17 and IL-23 levels were higher in AS cases than controls. Among AS cases, serum IL-1β and IL-23 levels were increased in MEFV 694V carriers compared with non-carriers. Our data suggest that FMF and AS have overlapping aetiopathogenic mechanisms. Functionally important MEFV mutations, such as M694V, lead to dysregulated inflammasome function and excessive IL-1β function. As IL-1 inhibition is effective in FMF, AS cases carrying FMF-associated MEFV variants may benefit from such therapy.

The aim of the study was to investigate the relationship of CPDAI with other follow-up parameters and to evaluate gender differences in measures in psoriatic arthritis (PsA) patients. This cross-sectional study included patients with PsA followed up at a rheumatology outpatient clinic. Disease activity was assessed using CPDAI, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analog Scale (VAS) and Disease Activity Score (DAS28). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured. The Psoriasis Area and Severity Index (PASI) was used to measure of severity of psoriasis. Bath Ankylosing Spondylitis Functional (BASFI) and Metrology Indexes (BASMI), Health Assessment Questionnaire (HAQ), AS Quality of Life (ASQoL) and Dermatology Life Quality Index (DLQI) were evaluated. There were 117 patients with PsA (78 female) who fulfilled the Classification Criteria for Psoriatic Arthritis. Their mean CPDAI score was 3.67 (± 2.46). The CPDAI was positively correlated with tender/swollen joint counts, dactylitis and enthesitis. There was strong positive correlation between CPDAI and BASDAI, DAS28 and VAS, but no correlation found between the CPDAI and ESR, CRP and BASMI. Mean CPDAI scores were similar in females and males. Female patients were found to have worse subjective scores including BASDAI, VAS, BASFI, HAQ and ASQoL than males (p < 0.05). However, objective disease parameters such as ESR, CRP, tender/swollen joint counts, DAS28 and BASMI were similar in both gender groups. This study confirmed that CPDAI, a compound scale to assess disease activity in PsA, was well correlated with other disease activity measurements. Although subjective disease scores were higher in female patients, CPDAI was not affected by gender.

BackgroundAn increased prevalence of metabolic syndrome (MetS) has been reported in psoriatic arthritis (PsA) suggesting an association between the inflammation and MetS.ObjectivesThe aim of this study is to investigate its relationship with disease activity in patients with PsA. We also evaluated whether an association exists between MetS and axial involvement in PsA.MethodsThis study included patients with PsA followed in the Rheumatology outpatient clinic at Dokuz Eylul University. Age-matched patients with Takayasu arteritis (TA), an inflammatory systemic disease, were enrolled as diseased controls. The NCEP-ACT III criteria were used to identify subjects with MetS. Disease activity was assessed in patients with PsA by using several parameters including BASDAI, ASDAS, VAS patients’ and physician’ global, Tender and Swollen joint assessment (28/68), DAS28, DAPSA, CPDAI and SPARCC Enthesitis Index. ESR and serum CRP levels were measured. BASFI and BASMI were used to evaluate functional status and HAQ, ASQoL and DLQI to evaluate health and PASI to measure the severity of psoriasis. Hand and pelvis X-rays and sacroiliac joint MRIs were performed when indicated.ResultsThere were 104 PsA patients (63.5% F; mean age: 50.9±13.0 years) who fulfilled the CASPAR criteria and 28 TA patients (89% F, mean age: 46.3±9.1) who fulfilled the ACR 1990 criteria. The prevalence of MetS was found to be considerably higher in PsA patients compared to TA patients (45.2% and 21.4% respectively, p<0.001). In the comparison of PsA patients with and without MetS, no differences were found regarding treatment frequencies of NSAIDs, glucocorticoids, DMARDs and anti-TNFs and also mean glucocorticoid dosages. PsA patients with MetS had higher BASDAI, BASFI, BASMI, VAS, ASqOL, CPDAI, ASDAS and HAQ scores compared to PsA patients without MetS (table 1). More patients with syndesmophytes were found among PsA patients with MetS compared to those without MetS (p=0.027). There were no differences in indexes related predominantly peripheral involvement, such as tender and swollen joint counts, enthesitis score and presence of dactylitis. In multivariable regression analysis, presence of syndesmophytes had no relationship with MetS, but still related with ESR and BASMI.Abstract AB0922 – Table 1Clinical features and disease activity parameters in PsA patients with and without MetS.ConclusionsThis study demonstrates a higher prevalence of MetS in PsA patients compared to TA. It also suggests that MetS might be associated with high disease activity and more severe disease especially in patients with axial involvement.Disclosure of InterestNone declared

BackgroundIntermalleolar distance (IMD) is a component of the Bath ankylosing spondylitis metrology index (BASMI) and measures abduction of the hips. New generations of smartphones are equipped with a gyroscope and an accelerometer which in combination with a smartphone's operating system or specific software applications can be used for various inclinometric functions.ObjectivesThe purpose of this study was to estimate the intra and inter-rater reliability of using iphone built in compass application, as compared to IMD in the assessment of hip abduction in patients with Ankylosing Spondylitis (AS).MethodsThe study sample included 20 AS patients (6 females, 14 males) with a mean age of 47.8 (±10.2). BASMI scores were obtained from patient charts. Two examiners measured intermalleolar distance as the standard method at two different time points with the patient lying in a supine position. Then combined abduction of the hips angle (CAHA) was measured by iPhone compass application twice. To stabilize the iphone's position during measurements an iphone case and an elastic bandage with velcro patches were used. Intra-rater and inter-rater reliability were examined with intra-class correlation coefficients (ICC). The validity was assessed by Pearson Correlation analysis.ResultsThe mean BASMI score was 43 (±22.7). The mean scores for BASDAI, ASDAS and BASFI were 3.7 (±19.9), 2.9 (±0.96) and the 3.5 (±24.02), respectively. The mean IMD was 83.6 cm (±24.4) for rater 1 and 83.4cm (SD: 23.1) for rater 2. The mean CAHA was 51.2° (±18.3) for rater 1 and 55.6°(±20.5) for rater 2. We observed almost an excellent intra and inter-rater reliability for both methods (Table 1). CAHA measurements showed a strong correlation with IMD (r=0.74).Table 1.Intra-rater and inter-rater reliability of the two methods to asses the hip mobilityIntrarater reliabilityInterrater reliabilityRater 1Rater 2ICC (95% CI)ICC (95% CI)ICC (95%CI)Intermalleolar distance0.99 (0.98–0.99)0.85 (0.66–0.94)0.93 (0.85–0.97)Combined hip abduction angle0.94 (0.85–0.97)0.84 (0.64–0.93)0.94 (0.85–0.97)ConclusionsThe results of this study suggest that measurement of combined hip abduction angle using iphone, which is not to be affected by patients' height, can be used as a novel hip mobility measure.Disclosure of InterestNone declared