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BackgroundThe course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses.ObjectiveIn this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs.MethodsBetween April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome.Results165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive.ConclusionsAmong IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome.

Background: There are few data on disease characteristics and outcome of coronavirus 2019 (COVID-19) among patients with inflammatory rheumatic diseases (IRDs). In this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among patients with IRDs.Methods: Between April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome.Results: 165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive.Conclusions: Among IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome.

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BackgroundExternal validation of the 2022 ACR/EULAR GPA, EGPA and MPA Classification Criteria is recommended by the DCVAS study group [1-3].ObjectivesTurkish Vasculitis Study (TRVaS) prospective cohort is an electronic database including 15 centres from all over Turkey. We aimed to test performance of the recent criteria sets in TRVaS cohort.MethodsPatients diagnosed according to physicians’ decisions have been recruited prospectively in TRVaS (in total 3730 patients by January 2023). 2022 ACR/EULAR and 1990 ACR Classification Criteria sets were applied to all of the patients with AAV [GPA (n=533), EGPA (n=112), MPA (n=105), and unclassified AAV (n=70)], poliarteritis nodosa (PAN, n=47) and IgA Vasculitis (n=76). Performances were analysed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.ResultsFor the patients with GPA, 2022 criteria had higher sensitivity and specifity compared to 1990’s (83.6% vs. 71.0% and 95.6% vs. 88.6%, respectively in Table). A significant increase was observed in sensitivity for 2022 criteria for patients with EGPA (86.4% vs.59.1%) with no change in specificity. Sensitivity and specificity of 2022 MPA criteria was calculated as 83.8% and 89.8%, respectively. Using the 2022 criteria to the patients with unclassified AAV, led to classify seven (10.0%) patients as GPA and 29 (41.0%) patients as MPA. Of 47 patients with PAN, one patient fulfilled 1990 ACR and another fulfilled 2022 GPA criteria. Others were not classified as EGPA or MPA. None of the patients with IgA vasculitis fulfilled 2022 AAV criteria. Of 533 patients with GPA, 1.5% fulfilled both 2022 GPA and MPA criteria and 7.7% fulfilled only MPA criteria (Figure). In each clinically diagnosed AAVs, around 10% of patients were not classified by any 2022 criteria.ConclusionUsing 2022 ACR/EULAR Classification Criteria, improved sensitivity and specifity for GPA and sensitivity for EGPA were observed. Additionally, half of the unclassified AAV patients could be classified as either GPA or MPA. These criteria functioned well for the discrimination of patients with AAV from other small/medium vessel vasculitides such as PAN and IgA vasculitis. In total, over 80% of the patients with AAV were accordingly classified in paralel to the clinical diagnosis in each GPA/EGPA/MPA.References[1]Robson, J.C.et al s.Ann Rheum Dis2022,81, 315-320.[2]Grayson, P.C. et al.Ann Rheum Dis2022,81, 309-314.[3]Suppiah, R.Ann Rheum Dis2022,81, 321-326.Figure.Classification of clinically diagnosed GPA/EGPA/MPA patients using 2022 ACR/EULAR criteria setsTable.Performance of 1990 ACR and 2022 ACR/EULAR criteriaGPANon-GPA AAVEGPANon-EGPA AAVMPANon-MPA AAVPAN + IgAV1990 ACR Wegener criteriaSn/Sp71/88.671/84----71/99.2PPV/NPV89.3/69.689.6/60----99.7/44Accuracy78.675.4----76.32022 ACR/EULAR GPASn/Sp83.6/95.683.6/94.1----83.6/99.2PPV/NPV96.3/81.296.5/74.5----99.8/58.2Accuracy88.787.1----86.51990 Churg-Strauss criteriaSn/Sp--59.1/10059.1/100--59.1/100PPV/NPV--100/94.6100/93.7--100/73.1Accuracy--9594.2--80.62022 ACR/EULAR EGPASn/Sp--86.4/99.886.4/99.8--86.4/100PPV/NPV--98.9/98.198.9/97.81--100/89.1Accuracy--98.297.9--93.52022 ACR/EULAR MPASn/Sp----83.8/89.883.8/87.983.8/100PPV/NPV----52.1/97.752.1/97.2100/87.8Accuracy----89.187.492.5Acknowledgements:NIL.Disclosure of InterestsNone Declared.

BackgroundSecukinumab (SEC), a human anti-IL-17A monoclonal antibody, has similar treatment response rates to tumor necrosis factor (TNF) inhibitors in patients with axial spondyloarthritis (SpA). However, the efficacy of SEC on anterior uveitis (AU) is unclear.ObjectivesThis study aimed to evaluate the risk of new-onset or relapsing AU in axial SpA patients treated with SEC.MethodsIn this prospective cohort study, 130 axial SpA patients receiving SEC at the TURKBIO registry between 2019 and 2021 were evaluated. Demographic and clinical characteristics and data about the presence of AU pre or post-treatment were collected. The univariate and multivariate logistic regression analyses were performed to evaluate the predictors of AU development.ResultsThe mean age of the patients (F/M: 59/71) was 47.4±10.9 years. The median follow-up time was 540 days (IQR: 330-630). SEC was the first biological agent in 50 (38.4%) patients and 35 (26.9%) patients were using at least one concomitant conventional synthetic DMARD (Table 1). While continued SEC therapy was in 93 (71.5%) patients, treatment withdrawal was in 37 cases (in 26 due to ineffectiveness, two adverse events and nine other reasons). Overall, 15(11.5%) patients had a history of AU before the SEC. During follow-up, AU attacks were seen in the 6 cases (4 were new-onset and 2 were flare) and 5 of these patients have a history of inadequate response to TNF inhibitors. The frequency of AU was calculated as 3.42 per 100 patient-years during SEC treatment. The only significant predictor of AU development was the baseline high C-reactive protein (CRP) level on multivariate analysis (p=0.003, OR: 1.063 [95% CI 1.021-1.107]).Table 1.Demographics and clinical characteristics of the patientsTotal (n:191)Gender (F/M)59/71Age (years) (mean±SD)47.4±10.9Diagnosis; n (%)   AS125 (96.2)   nr-axSpA5 (3.8)BASDAI (mean±SD)47.2±20.48   Missing n (%)4 (3.07)ASDAS (mean±SD)3.32±0.92   Missing n (%)14 (10.7)C-reactive protein (mg/L) median (IQR)12.6 (4.67-22.62)Sedimentation (mm/h) median (IQR)22 (9-42)Concomitant csDMARDs n (%)35 (26.9)Secukinumab dose n (%)   150 mg120 (92.3)   300 mg10 (7.7)TNFi-naive patients n (%)50 (38.5)Number of previous bDMARDs n (%)   136 (27.7)   223 (17.7)   ≥ 321 (16.1)History of previous TNFi n (%)   Monoclonal TNFi64   Etanercept16AS; Ankylosing spondylitis, nr-axSpA; Non radiographic axial spondyloarthritis, BASDAI; Bath Ankylosing Spondylitis Disease Activity Index, ASDAS; Ankylosing Spondylitis Disease Activity Score, csDMARD; conventional synthetic disease modifying anti-rheumatic drug, TNFi; Tumor necrosis factor inhibitors, bDMARD; biological DMARD. Datas were expressed as number (%), mean±SD or median (IQR).ConclusionIn this real-life data from the TURKBIO registry, the incidence of AU in axial SpA patients treated with SEC was calculated as 3.42 per 100 patient-years. A high baseline CRP level was an independent factor for developing AU.Disclosure of InterestsNone declared