BackgroundDeep vein thrombosis (DVT) is the most common form of vascular involvement in Behçet’s disease (BD). Post-thrombotic syndrome (PTS) refers to the symptoms and signs of chronic venous insufficiency following DVT. It develops within the first 2 years in more than half of the patients after acute DVT [1].ObjectivesIn this prospective study, we aimed to evaluate the risk of PTS development after DVT and the factors affecting the development and severity of PTS in BD patients.MethodsBD patients (n=18) with acute DVT and were followed in 3 tertiary rheumatology centers were included in the study. Patients are evaluated for PTS presence during acute DVT, 6-12. months and then annually. Villalta scoring with a total score of >4 or presence of venous ulcer was defined as PTS. PTS was classified as mild if the score was between 5-9, moderate between 10-14, and presence of >14/venous ulcers as severe. Venous Damage Score (VDS) was used to evaluate the effect of venous disease on work productivity and Venous Clinical Severity Score (VCSS) for symptom severity.ResultsThe clinical features of the 18 patients included in the study are shown in Table 1. Major-organ involvement was present in 12 patients (pulmonary involvement in 7 (39%), ocular involvement in 5 (28%), arthritis in 3 (13%), neurobehçet and enterobehçet each in 1 patient). Steroid and IS treatment was given to all patients after an acute DVT attack. Additional anticoagulant (AC) treatment was chosen in 16 of the patients. Patients were followed up for a median 23.2 (6-40) months after DVT. The number of patients followed for at least 1 year after an acute DVT attack was 15, and the median follow-up period was 26 (12-40) months. The median duration of AC use in patients who received AC treatment in the follow-up was 6 (0-12) months. PTS developed in 5 (33%) of 15 patients during follow-up. The baseline, 6th and 12th month course of Villalta, VCSS, and VDS scores are shown in figure 1.ConclusionIn this prospective follow-up after an acute DVT attack 33% of BD patients developed PTS within 1 year. In our previous retrospective study, 62% of 205 patients, half of whom received AK, developed PTS during follow-up [2]. Despite the limitations of our study, such as the low number of patients and the short follow-up period, AC treatment in all patients (except 1) may have influenced a lower PTS development in the prospective follow-up compared to the retrospective data.References[1]Baldwin MJ et al. J Thromb Haemost. 2013 May;11(5):795-805.[2]Aksoy Aet al. J Vasc Surg Venous Lymphat Disord 2021; 9:1451.Table 1.Characteristics of Study PatientsClinical manifestationsSS/StdAge, average33.56 (9.62)Female/male, n(%)4/14 (%22.2)Family history (BD)3 (%16.7)Oral ulcers16 (%88.9)Genital ulcers9 (%50)Papulopustular lesions(%61.1)erythema nodosum6 (%33.3)Pulmonary involvement7 (%38.9)Articular involvement3 (%16.6)Neurological involvement1 (%5.6)Ocular disease5 (%27.8)Gastrointestinal involvement1 (%5.6)Figure 1.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundSecondary Sjögren’s syndrome (sSS) accompanies many systemic rheumatic diseases at certain rates, including axial spondyloarthritis (axSpA).[1]There are some case reports in which psoriasis or psoriatic arthritis (PsA) with sSS co-existence.[2]However, the prevalence of sSS in psoriasis (PsO) and PsA is not fully addressed. Additionally, clinical and laboratory features that may be associated with sSS, and whether arthritis and sSS are related are not known.ObjectivesThis study aims to assess the prevalence of sSS in patients with non-arthritic psoriasis and PsA and illuminate disease features associated with sSS.MethodsPsoriasis patients diagnosed by a dermatologist and patients classified as PsA who fulfilled the CASPAR criteria were questioned for sicca symptoms consistent with the 2002 American-European Sjogren’s Syndrome Consensus Criteria (AECG). The salivary gland scintigraphy of the patients with oral dryness was performed and the unstimulated salivary flow rate (SFR) was measured. Schirmer’s test was performed on patients with dry eyes. Anti-Ro antibodies were measured and minor salivary gland biopsies were performed in patients with sicca detected by objective measurements. After the evaluation of the patients, the sSS was classified according to the 2002 AECG. The frequency of sSS in non-arthritic psoriasis and PsA patients were compared. In addition, PsA patients were divided into two groups according to the presence and absence of sSS. PsA-specific characteristics in these two groups were compared.ResultsOf the 184 psoriasis patients who participated in the study, 112 had PsA, and 72 had psoriasis without arthritis. There was no significant age difference between non-arthritic psoriasis and PsA patients (48.3±11.9 and 49.4±13.5, respectively; p=0.59) Similarly, female to male ratio (rates (%): non-arthritic psoriasis: 43/29 (59.7/40.3) PsA: 82/30 (73/27), respectively; p= 0.08) and age of onset of psoriatic skin changes (mean (SD) of non-arthritic psoriasis: 30.3 ±10.9, PsA: 29.4 ±13.2, respectively; p=0.68) did not differ between non-arthritic psoriasis and PsA patients. sSS was more prevalent in PsA patients when compared with the non-arthritic psoriasis group (PsA: 20 (%17.9), non-arthritic psoriasis: 1 (%1.3), p<0.001). None of the patients had a previous diagnosis of sSS. Of the patients with sSS (n=20), 18 had salivary gland involvement detected in salivary gland scintigraphy, four Anti-Ro positivity, and three low unstimulated SFR. All PsA patients with sSS (sSS/PsA) had a positive Schirmer test.sSS/PsA patients were significantly more positive for ANA and had plantar fasciitis more frequently than PsA patients without sSS (Table 1). Although not statistically significant, the age of onset of joint involvement in sSS/PsA patients was higher and was treated less with biological therapy (Table 1).ConclusionSecondary Sjögren’s syndrome is part of the clinical picture in a substantial proportion of PsA patients and its absence in non-arthritic PsO implies that sSS is arthritis associated. Whether the type of arthritis in sSS/PsA patients has a pattern necessitates larger patient numbers. A higher rate of ANA positivity may suggest the role of B lymphocytes in the progression from PsO to PsA.References[1]Brandt et al, 1998[2]Yamamoto T and Yokoyama A,1996.Table 1- Comparison of PsA patients with and without sSSPresence of sSSn=20Absence of sSSn=92pAge mean (SD)53.948.40.09Female/Male ratio18/261/270.08Age of onset of skin involvements mean (SD)30.629.40.74Age of onset of joint involvements mean (SD)42.637.40.09Axial Involvement n (%)6 (35.3)25 (29.4)0.77Polyarthritis n (%)4 (22.2)11 (14.9)0.29Heel Enthesitis n (%)5 (31.3)12 (21.4)0.19Plantar Fasciitis n (%)5 (31.3)6 (9)0.03RF positivity n (%)1 (7.7)1 (1.9)0.36ANA positivity n (%)10 (55.6)12 (27.2)0.04Biological therapy ever n (%)10 (50)63 (72.4)0.06sSS: Secondary Sjögren’s syndrome, SD: Standard deviation, RF: Rheumatoid Factor, ANA: Anti-Nuclear Antibody, PsA: Psoriatic ArthritisAcknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundInflammation of the lacrimal glands leads to ocular dryness, an important cause of decreased quality of life in primary Sjögren’s syndrome (pSS) patients[1]. Limited data focuses on dry eye disease (DED) in pSS. Previous studies did not conduct a comprehensive evaluation of DED using tests to measure tear film volume or instability, ocular surface damage, meibomian gland dysfunction, and patient-reported outcomes, and the disease activity parameters were not compared with these ocular findings in pSS[2].ObjectivesThe aim of this study is to conduct a comprehensive evaluation of DED features in pSS patients using various methods and compare them to pSS disease characteristics and activity.MethodsThirty-four patients classified as pSS according to 2016 ACR/EULAR classification criteria[1]that are followed up in rheumatology clinic were included in the study. The patients had an ophthalmologic examination and DED evaluation on the day of their routine follow-up appointments. ESSPRI scores was recorded and laboratory tests, salivary flow rate and salivary gland ultrasonography(USG) scores of the patients were recorded from the patients’ files. The ophthalmologic examination includes Schirmer’s test, BUT, ocular surface staining (Oxford score), Marx’s line, and noninvasive BUT (NIBUT) with the Scheimplug-Placido disk system. Ocular surface disease index (OSDI) and dry eye questionnaire-5 (DEQ-5) were used for patient-reported outcomes. The relationship between the pSS-related parameters and the ophthalmologic findings was evaluated.ResultsThe patient characteristics are given in Table 1. According to the TFOS-DEWSII definition and classification report, all patients have definite DED[3]. The mean Schirmer’s test, BUT, and NIBUT were 3.4±5.2 mm, 5.9±3.0 sec, and 5.9±3.9 sec, respectively. The mean OSDI score was 38.2±22.7, indicating severe DED symptoms, and the mean DEQ-5 score was 10.3±6.0. Oxford score was positive in 25 (73.5%) patients. Marx’s line grading that shows meibomian gland dysfunction was 3.2±2.3.The mean ESSPRI score for dryness, pain, and fatigue were 6.5±2.1, 5.4±3.2, and 5.3±3.1, respectively. There was a significant positive correlation between the ESSPRI-dryness score and OSDI (p=0.001), DEQ-5 (p=0.004), and Oxford score (p=0.03).Also, there was a significant negative correlation between patient global assessment (PGA) of general health and DEQ-5 scores (p=0.007). And there was a significant positive correlation between PGA of disease activity and OSDI and DEQ-5 scores (p=0.02 and p=0.001).Although seventeen (50%) of the patients have decreased unstimulated salivary flow rate with a median of 0.16 (0.24) ml/min, no significant correlation was observed with DED. The results of salivary gland USG were present in 12 (35.2%) of the patients, and there were 7 patients with at least one gland with an OMERACT USG score ≥2. No significant difference was found between OMERACT USG score and DED parameters, although it remained within the statistical siginificant limit for OSDI score and OMERACT USG score ≥2 in the submandibular glands (p=0.054).There was no significant difference between the DED parameters and other pSS clinical parameters.ConclusionPatient-reported outcomes such as ESSPRI-dryness score, PGA of general health, and disease activity worsen as DED severity increases in pSS patients.References[1]Shiboski CH, et al. Ann Rheum Dis. 2017[2]Seror R, et al. Rheumatology (Oxford). 2019[3]Craig JP, et al. Ocul Surf. 2017Table 1.The characteristics of the study populationAge, years,mean±sd49.5± 13.3Sex, female,n (%)33 (97.1)Disease duration, months,median (IQR)73.5 (76.5)Treatment,n (%) Hydroxychloroquine Methotrexate Leflunomide Azathioprine Mycophenolate mofetil Rituximab24 (70.6)6 (17.6)6 (17.6)4 (11.8)2 (5.9)2 (5.9)Disease manifestations,n (%) Arthralgia Arthritis Parotitis Interstitial lung disease Lymphopenia Hypergammaglobulinemia Hypocomplementemia31 (91.2)11 (32.4)2 (5.9)4 (11.3)7 (20.6)12 (35.3)4 (11.8)Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundThe Coronavirus disease 2019 (COVID-19) has affected more than two hundred million individuals and many risk factors for increased mortality and morbidity in COVID-19 have defined. There are many studies evaluating the effect of immunosuppressants used in inflammatory rheumatic diseases in the course of COVID-19. (1,2) However, fewer data are available on the course of COVID-19 in patients with Takayasu arteritis (TAK).ObjectivesIn this study, we aimed to evaluate the characteristics and outcomes of TAK patients with COVID-19.MethodsA phone survey was conducted among TAK patients that are followed up in our clinic between February 2021 and March 2021. All patients were asked whether they were diagnosed as COVID-19 during the pandemic. The patients who had a history of confirmed COVID-19 were asked about the symptoms, hospitalization status and the treatment received for COVID-19. Information about their chronic diseases were obtained from the patient files.ResultsAmong 118 TAK patients, 15 had COVID-19 infection during the first year of pandemic, 13 of them were female and mean age was 42,5 ± 12,0 years. None of the patients had been vaccinated before the diagnosis of COVID-19. Nine of the patients were taking prednisone therapy and 3 of them were taking moderate to high doses of glucocorticoids during the infection period. Twelve patients were taking conventionally synthetic disease-modifying antirheumatic drugs (csDMARDs), 7 patients were taking biological disease-modifying antirheumatic drugs (bDMARDs), and 5 patients were taking a combination of csDMARD and bDMARD therapy when they were diagnosed with COVID-19. Two patients were hospitalized; one of them required nasal oxygen support and discharged after 5 days. The other patient was 61 years old and had multipl comorbidities and had admitted to intensive care unit for 5 days. One patient who had a mild COVID-19 disease had pulmonary thromboembolism 2 weeks after the infection and his symptoms resolved after starting anticoagulation therapy. All of the patients fully recovered and had no mortality related to COVID-19.ConclusionTo our knowledge, this is the largest cohort reporting the course of COVID-19 in TAK patients. Our data suggest that there is no increased risk for morbidity or mortality related to COVID-19 in TAK patients.References[1]Strangfeld A, Schäfer M, Gianfrancesco MA, et al.; COVID-19 Global Rheumatology Alliance. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis. 2021 Jul;80(7):930-942.[2]Andersen KM, Bates BA, Rashidi ES, et al.; National COVID Cohort Collaborative Consortium. Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative. Lancet Rheumatol. 2021 Nov 15.Disclosure of InterestsNone declared
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