According to the literature, PTH determination in washout samples has a specificity of 75%-100% and sensitivity of 70%-100%. This approach has better results than both cytology and scintigraphy in case of concomitant multinodular thyroid disease in experienced hands. Although there is not a definite cut-off for PTH levels in washout samples, we agree with the need of ratios rather than cut-offs in this issue.

Background/aim To evaluate treatment adherence and predictors of drug discontinuation among patients with inflammatory arthritis receiving bDMARDs within the first 100 days after the announcement of the COVID-19 pandemic. Materials and methods A total of 1871 patients recorded in TReasure registry for whom advanced therapy was prescribed for rheumatoid arthritis (RA) or spondyloarthritis (SpA) within the 3 months (6–9 months for rituximab) before the declaration of COVID-19 pandemic were evaluated, and 1394 (74.5%) responded to the phone survey. Patients’ data regarding demographic, clinical characteristics and disease activity before the pandemic were recorded. The patients were inquired about the diagnosis of COVID-19, the rate of continuation on bDMARDs, the reasons for treatment discontinuation, if any, and the current general disease activity (visual analog scale, [VAS]). Results A total of 1394 patients (493 RA [47.3% on anti-TNF] patients and 901 SpA [90.0% on anti-TNF] patients) were included in the study. Overall, 2.8% of the patients had symptoms suggesting COVID-19, and 2 (0.15%) patients had PCR-confirmed COVID-19. Overall, 18.1% of all patients (13.8% of the RA and 20.5% of the SpA; p = 0.003) discontinued their bDMARDs. In the SpA group, the patients who discontinued bDMARDs were younger (40 [21–73] vs. 44 years [20–79]; p = 0.005) and had higher general disease activity; however, no difference was relevant for RA patients. Conclusion Although the COVID-19 was quite uncommon in the first 100 days of the pandemic, nearly one-fifth of the patients discontinued bDMARDs within this period. The long-term effects of the pandemic should be monitored.

Background:Hand articular damage occurs in rheumatoid arthritis (RA) and functional ability deteriorates as the disease progresses. Limitation of hand motion, oedema, pain etc. factors contribute to reduce grip strength, pinch strength and joint position sense; this problems contribute to function and disability. Following RA, affecting grip and pinch strength (1) and joint position sense (2) was reported former research. But there is a little knowledge about disabilitiy of hand functions in psoriatic arthritis (PsA).Objectives:To compare joint position sense, grip strength and pinch strength in patient with PsA and RA.Methods:In our cross sectional study, 23 RA patients [Mean age; 52.7±12.6, Women:20(87.0%)] who were classified according to the ACR 2010 criteria and 19 PsA patients [Mean age 53.5±12.6, Women:14 (%73.7)] who were classified according to the CASPAR criteria were included.It was recorded demographic and clinical data of patients. Wrist position sense was evaluated by goniometric re-position error test (in 30◦ wrist extansion, 3 repeat). Grip strenght was examined using a hand dynamometer (Lafayette Proffessional Hand Dynamometer, USA) and pinch strength (two point, three point, lateral) was evaluated by pinchmeter (Lafayette,USA).Results:Patients were similar in terms of age, gender, disease duration, morning stiffness duration, pain of hand joints, number of tender and swallen joints and disease activity (p>0.05). RA patients had longer disease duration (p=0.004) and lower ESR levels (p=0.046) compared to PsA. Grip and pinch strength were found similar in both dominant and non-dominant side between RA and PsA patients (Table 1). Wrist joint position error was higher in PsA group in non-dominant side (p=0.011).Table 1.Comparison of Groups for Grip and Pinch Strength and Joint Position SenseVariablesRA(n=23)Median(IQR)PsA(n=19)Median(IQR)p*Grip StrengthDominantNon-dominant20(14/25)20(14/25)25(20/29)21(15/26)0.1090.404Pinch StrengthDominant2 Point3 PointLateralNondominant2 Point3 PointLateral3.1(2.2/3.8)3(2.3/4.0)3.4(3.0/4.2)3(1.9/3.7)2.8(2.3/3.8)2.9(2.5/4.0)3(2.2/3.4)3.4(2.5/4.20)3.5(2.6/4.5)3(2.4/3.7)3.1(2.3/4.2)3.2(2.4/4.2)0.8100.4710.8400.7140.7230.561Joint Position ErrorDominantNon-dominant6(5/7)6(3/8)7(5/9)8(6/11)0.2340.011Data have shown as median (interquartile range 25-75) *Mann Whitney-U TestConclusion:Our study showed that patients with PsA had hand impairment as much as RA patients. We think, hand assessment in patients with PsA rehabilitation programme is essential for clinicians. There is need future studies including asymptomatic healthy group to interpret of results in detailed.References:[1]VLIET, TP Vlieland, et al. Determinants of hand function in patients with rheumatoid arthritis. The Journal of rheumatology, 1996, 23.5: 835-840.[2]FERRELL, W. R.; CRIGHTON, A.; STURROCK, R. D. Position sense at the proximal interphalangeal joint is distorted in patients with rheumatoid arthritis of finger joints. Experimental Physiology: Translation and Integration, 1992, 77.5: 675-680.Disclosure of Interests:None declared

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease mainly affecting sacroiliac joints and spine. Peripheral arthritis, dactylitis and enthesitis may also occur. Extra musculoskeletal manifestations (EMMs; uveitis [AAU], inflammatory bowel disease [IBD] and psoriasis [Pso] are among the most common ones) are important features and might have an impact on the disease burden in patients with axSpA. The presence of EMM, in particular IBD and AAU could influence the choice of TNFi however little is known regarding the role of peripheral manifestations together with the EMM on the prescribing patterns in axSpA patients.Objectives:To examine the frequency of peripheral and EMMs in a real-world axSpA cohort and their effect on the choice of first advanced treatment.Methods:In total 1687 axSpA patients (58% male and the mean age (±SD) was 38.5 ± 10.9) who initiated his/her first biologic were included in the present analysis. The data for the current study was obtained from the TReasure web-based registry; in which RA and SpA patients treated with bDMARDs from different regions of Turkey. Baseline demographic, disease related characteristics, peripheral and EMMs were extracted. Characteristics of patients with and without peripheral/extra-musculoskelatal involvement were compared as well as factors/covariates associated with the choice of first TNFi and secukinumab was analysed.Results:Enthesis (28.2%) was found the most common peripheral manifestations and peripheral arthritis (26.4%) and hip arthritis (24.4%) followed it. Symptom duration to the first advanced treatment initiation was significantly shorter in axSpA patients with peripheral arthritis, enthesitis, dactylitis and psoriasis and longer in hip arthritis and AAU. HLA-B27 positivity was significantly lower in patients with arthritis, psoriasis and IBD and higher with hip arthritis and AAU. In multivariate analysis the presence of IBD is significantly associated with the preference of monoclonal TNFi (mab) over etanercept (ETA) (OR 5,770; 95%CI 1.788-18.616). However ETA was preferred in patients with hip arthritis (p=0.003), longer symptom duration (p=0.049), and using sulfasalazine (p=0.043). In comparison with mabs, secukinumab (SEC) prescription was found to be significantly associated with higher age (p=0.001), sulfasalazin (p=0.001) and methotrexate usage (p=0.053) among axSpA patients need their first advanced treatment.Conclusion:The results of the current study confirm the pathophsyologic associations of peripheral involvement and EMM in axSpA patients. Apart from hip arthritis the presence of IBD has an impact on the prescription of advanced treatment in real-life.Table 1.Clinical characteristics of patients in cohortAll patients(n=1678)Peripheral arthritis(n=445)Dactilitis(n=81)Enthesis(n=476)Uveitis(n=193)Psoriazis(n=152)IBD(n=78)Hip involvemet(n=412)Age, mean±SD38,5±10,938,3±11,637,4±11,137,9±10,741,3±11,439,9±11,341,6±12,239,2±11,2Male sex,n (%)974 (57,7)184 (41,3)34 (42)238 (50)96 (49,7)54 (35,5)43 (55,1)272 (66)Symptom duration, mean month±SD108,5±98,996,9±92,979,1±76,5100,4±92,7144,7±110,287,7±9494,5±98133,3±108,2HLA B27 positivity, n (%)621 (53,7)142 (46,3)27 (51,9)174 (49,4)104 (77)34 (36,2)16 (27,1)186 (59,8)Concomitant cDMARD usage (yes), n (%)420 (24,9)170 (38,2)39 (48,1)133 (27,9)53 (27,5)58 (38,2)24 (30,8)99 (24)BASDAİ,mean±SD5,1±2,55,1±35,3±3,15,3±2,94,7±2,55,6±2,44,8±2,35,3±2,1ASDAS-CRP, mean±SD3,1±1,52,6±1,92,5±1,82,8±1,72,9±1,73,4±1,33,1±1,53,7±1,4Disclosure of Interests:None declared

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