Browsing by Author "Akkoc, N"
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Item Do mobility exercises in different environments have different effects in ankylosing spondylitis?Gurpinar, B; Ilcin, N; Savci, S; Akkoc, NAims: Ankylosing spondylitis (AS) reduces spinal mobility, which results in structural and functional impairments. Pulmonary problems eventually occur in most AS patients due to interstitial lung disease or as a result of chest wall abnormalities. The aim of this study was to evaluate the effects on pulmonary functions and disease related scales of aquatic and land-based multidimensional functional mobility exercises on pulmonary functions in patients with AS. Methods: In this randomized controlled study, 57 patients with definite AS according to the modified New York criteria were randomly allocated to an aquatic (AG), land-based (LG), or home (HG) exercise group and performed multidimensional mobility exercise sessions twice a week for 8 weeks. The Bath indices were used to measure disease activity, functional limitation, and spinal mobility, and a 10-cm visual analog scale assessed pain during activity and at rest. Pulmonary function tests, maximal inspiratory mouth pressure (MIP), and maximal expiratory mouth pressure (MEP) were measured before and after the intervention. The study is registered at ClinicalTrials.gov, number NCT03667625 (27/08/2018). Results: Forty-six patients (30.4% female) with a mean age of 42.0 years completed the study. Multidimensional exercises improved disease-related symptoms such as pain, spinal mobility, and functionality, but there were no significant changes in HG. Patients in AG showed significant improvements in peak expiratory flow (p=0.004), vital capacity ( p=0.025), maximum voluntary ventilation (p=0.006), and MIP (p=0.001), while those in LG showed significant increases in forced expiratory volume during the first second to forced vital capacity (FEV1/FVC) ratio (p=0.049), peak expiratory flow (p=0.007), and maximum voluntary ventilation (p=0.004). There were no significant changes in HG. Conclusions: Multidimensional functional mobility exercises performed either in water or on land are important in the management of pulmonary manifestations of AS.Item JAK Inhibitors for Axial Spondyloarthritis: What does the Future Hold?Akkoc, N; Khan, MAPurpose of Review To discuss the potential role of JAK inhibitors (JAKis) as a new therapeutic class for the treatment of axial spondyloarthritis (axSpA, including ankylosing spondylitis [AS] and non-radiographic axSpA [nr-axSpA]). Recent Findings A phase III randomized controlled trial of tofacitinib (a pan JAKi) in patients with active AS was found to be superior to placebo in achieving the ASAS20 primary endpoint at week 16 (56.4% and 29.4%, p < 0.0001, phase II trials of AS). Upadacitinib, a JAK1 inhibitor, has also been evaluated in a phase III trial for its efficacy and safety in AS. The primary endpoint, ASAS40 at week 16, was reached by 52% of the patients randomized to upadacitinib and 26% of the patients receiving placebo (p = 0 center dot 0003). All the important secondary endpoints also improved with both agents. No new changes in their safety profile were noted. However, the more frequent occurrence of cardiovascular and cancer adverse events associated with tofacitinib than with TNFi observed in the very recent post-marketing ORAL surveillance safety study, the results of which were released on January 27, 2021, may lead to safety concerns swirling around the whole class of JAKis. JAKis seem to be effective in treating signs and symptoms of AS but have not been studied in nr-axSpA. Both tofacitinib and upadacitinib have been pre-registered with the FDA for the treatment of AS. Upadacitinib has just recently received approval for this indication in the European Union..Item Is Axial Spondyloarthritis More Common Than Rheumatoid Arthritis?Akkoc, N; Khan, MAPurpose of Review To discuss the disease incidence and prevalence rates of axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS) relative to those of rheumatoid arthritis (RA). Recent Findings According to the most recently published systematic reviews, pooled prevalence estimates for RA are 0.38% in North America, and 0.21 to 0.25% in European subregions, while that of AS is 0.20% in North America and 0.25% in Europe. The estimated prevalence of axSpA has been reported to be approximately twice as common as AS in a study from the USA. This finding has also been supported by studies from northern Norway, central Italy, western Turkey, northern and southern regions of China, and rural Taiwan. These data suggest that axSpA, that encompasses AS, may be more prevalent than RA, at least in some countries. In general, higher occurrences of RA relative to AS have been noted worldwide, both in terms of incidence and prevalence. But axSpA, that encompasses AS, may be more prevalent than RA, at least in some countries. There is a need for concurrently run studies in the same population for a reliable comparison to establish occurrence of RA, AS, and axSpA. It is hoped that the implementation of the ICD-11 codes for axSpA will be helpful in determining a more accurate estimate of its incidence and prevalence.Item Development and Implementation of the AIDA International Registry for Patients With VEXAS SyndromeVitale, A; Caggiano, V; Della Casa, F; Hernandez-Rodriguez, J; Frassi, M; Monti, S; Tufan, A; Telesca, S; Conticini, E; Ragab, G; Lopalco, G; Almaghlouth, I; Pereira, RMR; Yildirim, D; Cattalini, M; Marino, A; Giani, T; La Torre, F; Ruscitti, P; Aragona, E; Wiesik-Szewczyk, E; Del Giudice, E; Sfikakis, PP; Govoni, M; Emmi, G; Maggio, MC; Giacomelli, R; Ciccia, F; Conti, G; Ait-Idir, D; Lomater, C; Sabato, V; Piga, M; Sahin, A; Opris-Belinski, D; Ionescu, R; Bartoloni, E; Franceschini, F; Parronchi, P; de Paulis, A; Espinosa, G; Maier, A; Sebastiani, GD; Insalaco, A; Shahram, F; Sfriso, P; Minoia, F; Alessio, M; Makowska, J; Hatemi, G; Akkoc, N; Li Gobbi, F; Gidaro, A; Olivieri, AN; Al-Mayouf, SM; Erten, S; Gentileschi, S; Vasi, I; Tarsia, M; Mahmoud, AAMA; Frediani, B; Alzahrani, MF; Laymouna, AH; Ricci, F; Cardinale, F; Jahnz-Rozyk, K; Tosi, GM; Crisafulli, F; Balistreri, A; Dagostin, MA; Ghanema, M; Gaggiano, C; Sota, J; Di Cola, I; Fabiani, C; Giardini, HAM; Renieri, A; Fabbiani, A; Carrer, A; Bocchia, M; Caroni, F; Rigante, D; Cantarini, LObjective: The aim of this paper is to present the AutoInflammatory Disease Alliance (AIDA) international Registry dedicated to Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome, describing its design, construction, and modalities of dissemination. Methods: This Registry is a clinical, physician-driven, population- and electronic-based instrument designed for the retrospective and prospective collection of real-life data. Data gathering is based on the Research Electronic Data Capture (REDCap) tool and is intended to obtain real-world evidence for daily patients' management. The Registry may potentially communicate with other on-line tools dedicated to VEXAS syndrome, thus enhancing international collaboration and data sharing for research purposes. The Registry is practical enough to be easily modified to meet future needs regarding VEXAS syndrome. Results: To date (April 22(nd), 2022), 113 Centers from 23 Countries in 4 continents have been involved; 324 users (114 Principal Investigators, 205 Site Investigators, 2 Lead Investigators, and 3 data managers) are currently able to access the registry for data entry (or data sharing) and collection. The Registry includes 4,952 fields organized into 18 instruments designed to fully describe patient's details about demographics, clinical manifestations, symptoms, histologic details about skin and bone marrow biopsies and aspirate, laboratory features, complications, comorbidities, therapies, and healthcare access. Conclusion: This international Registry for patients with VEXAS syndrome will allow the achievement of a comprehensive knowledge about this new disease, with the final goal to obtain real-world evidence for daily clinical practice, especially in relation to the comprehension of this disease about the natural history and the possible therapeutic approaches.Item Polygenic Risk Scores have high diagnostic capacity in ankylosing spondylitisLi, ZX; Wu, X; Leo, PJ; De Guzman, E; Akkoc, N; Breban, M; Macfarlane, GJ; Mahmoudi, M; Marzo-Ortega, H; Anderson, LK; Wheeler, L; Chou, CT; Harrison, AA; Stebbings, S; Jones, GT; Bang, SY; Wang, G; Jamshidi, A; Farhadi, E; Song, J; Lin, L; Li, MM; Wei, JCC; Martin, NG; Wright, MJ; Lee, M; Wang, YQ; Zhan, J; Zhang, JS; Wang, XB; Jin, ZB; Weisman, MH; Gensler, LS; Ward, MM; Rahbar, MH; Diekman, L; Kim, TH; Reveille, JD; Wordsworth, BP; Xu, HJ; Brown, MAObjective We sought to test the hypothesis that Polygenic Risk Scores (PRSs) have strong capacity to discriminate cases of ankylosing spondylitis (AS) from healthy controls and individuals in the community with chronic back pain. Methods PRSs were developed and validated in individuals of European and East Asian ethnicity, using data from genome-wide association studies in 15 585 AS cases and 20 452 controls. The discriminatory values of PRSs in these populations were compared with other widely used diagnostic tests, including C-reactive protein (CRP), HLA-B27 and sacroiliac MRI. Results In people of European descent, PRS had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.924.This was significantly better than for HLA-B27 testing alone (AUC=0.869), MRI (AUC=0.885) or C-reactive protein (AUC=0.700). PRS developed and validated in individuals of East Asian descent performed similarly (AUC=0.948). Assuming a prior probability of AS of 10% such as in patients with chronic back pain under 45 years of age, compared with HLA-B27 testing alone, PRS provides higher positive values for 35% of patients and negative predictive values for 67.5% of patients. For PRS, in people of European descent, the maximum positive predictive value was 78.2% and negative predictive value was 100%, whereas for HLA-B27, these values were 51.9% and 97.9%, respectively. Conclusions PRS have higher discriminatory capacity for AS than CRP, sacroiliac MRI or HLA-B27 status alone. For optimal performance, PRS should be developed for use in the specific ethnic groups to which they are to be applied.Item Identification of susceptibility loci for Takayasu arteritis through a large multi-ancestral genome-wide association studyOrtiz-Fernández, L; Saruhan-Direskeneli, G; Alibaz-Oner, F; Kaymaz-Tahra, S; Coit, P; Kong, XF; Kiprianos, AP; Maughan, RT; Aydin, SZ; Aksu, K; Keser, G; Kamali, S; Inanc, M; Springer, J; Akar, S; Onen, F; Akkoc, N; Khalidi, NA; Koening, C; Karadag, O; Kiraz, S; Forbess, L; Langford, CA; McAlear, CA; Ozbalkan, Z; Yavuz, S; Çetin, GY; Alpay-Kanitez, N; Chung, S; Ates, A; Karaaslan, Y; McKinnon-Maksimowicz, K; Monach, PA; Ozer, HTE; Seyahi, E; Fresko, I; Cefle, A; Seo, P; Warrington, KJ; Ozturk, MA; Ytterberg, SR; Cobankara, V; Onat, AM; Duzgun, N; Bicakcigil, M; Yentür, SP; Lally, L; Manfredi, AA; Baldissera, E; Erken, E; Yazici, A; Kisacik, B; Kasifoglu, T; Dalkilic, E; Cuthbertson, D; Pagnoux, C; Sreih, A; Reales, G; Wallace, C; Wren, JD; Cunninghame-Graham, DS; Vyse, TJ; Sun, Y; Chen, HY; Grayson, PC; Tombetti, E; Jiang, LD; Mason, JC; Merkel, PA; Direskeneli, H; Sawalha, AHTakayasu arteritis is a rare inflammatory disease of large arteries. We performed a genetic study in Takayasu arteritis comprising 6,670 individuals (1,226 affected individuals) from five different populations. We discovered HLA risk factors and four non-HLA susceptibility loci in VPS8, SVEP1, CFL2, and chr13q21 and reinforced IL12B, PTK2B, and chr21q22 as robust susceptibility loci shared across ancestries. Functional analysis proposed plausible underlying disease mechanisms and pinpointed ETS2 as a potential causal gene for chr21q22 association. We also identified >60 candidate loci with suggestive association (p < 5 x 10(-s)) and devised a genetic risk score for Takayasu arteritis. Takayasu arteritis was compared to hundreds of other traits, revealing the closest genetic relatedness to inflammatory bowel disease. Epigenetic patterns within risk loci suggest roles for monocytes and B cells in Takayasu arteritis. This work enhances understanding of the genetic basis and pathophysiology of Takayasu arteritis and provides clues for potential new therapeutic targets.Item Assessing safety and efficacy of TNFi treatment in late onset ankylosing spondylitis: a TURKBIO registry studyUslu, S; Gulle, S; Sen, G; Cefle, A; Yilmaz, S; Kocaer, SB; Inel, TY; Koca, SS; Yolbas, S; Ozturk, MA; Senel, S; Inanc, N; Dalkilic, HE; Gunduz, OS; Tufan, A; Akar, S; Birlik, AM; Sari, I; Akkoc, N; Onen, FClinical data on the use of tumour necrosis factor inhibitors (TNFi) in late-onset ankylosing spondylitis (LoAS) are limited. The present study aimed to evaluate efficacy, safety, and treatment adherence associated with the initial use of TNFi therapy in biologic naive patients diagnosed with LoAS. Patients whose age of onset was >= 45 years and < 45 years were classified as having LoAS and YoAS, respectively, based on the age of symptom onset. There were 2573 patients with YoAS and 281 LoAS. Baseline disease activity measures were similar between the groups. No significant differences were seen between the two groups in response to treatment and in remaining on the first TNFi at 6, 12 and 24 months. In the LoAS group, the analysis showed that TNFi discontinuation was linked to VAS pain score (HR 1.04; 95% CI 1.01-1.06). Patient groups had similar rates of adverse events (YoAS: 8.7% vs. LoAS: 11.7%). In both biologic naive LoAS and YoAS patients, the study showed that the initial TNFi therapy was equally effective and safe.Item THE EFFICACY AND SAFETY OF ANTI-TNF A TREATMENT IN ANKYLOSING SPONDYLITIS PATIENTS WITH LATE ONSET COMPARED TO THOSE WITH ADULT ONSET; THE DATA FROM TURKBIO REGISTRYUslu, S; Can, G; Cefle, A; Yilmaz, S; Kocaer, SB; Inel, TY; Gülle, S; Koca, SS; Yolbas, S; Öztürk, MA; Senel, S; Inanc, N; Dalkiliç, E; Soysal, O; Tufan, A; Akar, S; Birlik, M; Sari, I; Akkoc, N; Onen, FItem INCIDENCE OF ANTERIOR UVEITIS IN AXIAL SPONDYLOARTHRITIS DURING SECUKINUMAB TREATMENT: TWO YEARS REAL LIFE EXPERIENCE FROM TURKBIO REGISTRYAkleylek, C; Akar, S; Cinakli, H; Sagir, RP; Coskun, BN; Karakas, A; Apaydin, H; Kardas, RC; Isik, OO; Hakbilen, S; Okyar, B; Sosyal, O; Koca, SS; Pehlivan, Y; Dalkiliç, E; Can, G; Sari, I; Birlik, M; Onen, F; Erten, S; Ozturk, MA; Yazici, A; Cefle, A; Yilmaz, S; Cetin, GY; Akkoc, N; Yilmaz, NItem LONG-TERM SURVIVAL OF THE FIRST BIOLOGIC TREATMENT IN PSORIATIC ARTHRITIS AND THE EFFECT OF THE SELECTED TREATMENT ON DRUG SURVIVAL; TURKBIO REGISTRYKocaer, SB; Inel, TY; Erez, Y; Avsar, AK; Uslu, S; Karakas, A; Gulle, S; Can, G; Sari, I; Birlik, M; Dalkiliç, E; Pehlivan, Y; Akar, S; Cefle, A; Öztürk, MA; Yolbas, S; Yilmaz, N; Erten, S; Akkoc, N; Onen, FItem Genome-wide association study in Turkish and Iranian populations identify rare familial Mediterranean fever gene (MEFV) polymorphisms associated with ankylosing spondylitisLi, ZX; Akar, S; Yarkan, H; Lee, SK; Çetin, P; Can, G; Kenar, G; Çapa, F; Pamuk, ON; Pehlivan, Y; Cremin, K; De Guzman, E; Harris, J; Wheeler, L; Jamshidi, A; Vojdanian, M; Farhadi, E; Ahmadzadeh, N; Yüce, Z; Dalkiliç, E; Solmaz, D; Akin, B; Dönmez, S; Sari, I; Leo, PJ; Kenna, TJ; Önen, F; Mahmoudi, M; Brown, MA; Akkoc, NAnkylosing 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-1, 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 = 7.63x10(-12)), Iranian cohort (OR = 2.9, P = 0.042), and combined dataset (OR = 5.1, P = 1.65x10(-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 = 8.93x10(-15)), but also positive in HLA-B27-positive cases (OR = 4.3, P = 7.69x10(-8)). Serum IL-1, IL-17 and IL-23 levels were higher in AS cases than controls. Among AS cases, serum IL-1 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-1 function. As IL-1 inhibition is effective in FMF, AS cases carrying FMF-associated MEFV variants may benefit from such therapy. Author summary Ankylosing spondylitis (AS) is a highly heritable immune-mediated arthritis. To identify new genetic associations with AS, we performed genome-wide association studies in Turkish and Iranian AS patients and controls. We identified a novel rare coding MEFV variant associated with AS. Rare polymorphisms of MEFV, which encodes the protein pyrin, are known to cause Familial Mediterranean Fever (FMF), a monogenic, autosomal recessive, autoinflammatory disease which can be complicated by arthritis. 99.6% of Turkish AS cases, and 96% of those carrying the MEFV variant, did not have FMF, and the association with AS remains excluding cases with FMF. In Turkish subjects, the MEFV variant association was particularly strong in HLA-B27-negative cases, but also positive in HLA-B27-positive cases. This represents the first rare variant association with AS, and has the highest odds ratio for AS of any non-MHC reported hitherto, indicating a major effect on disease pathogenesis. We assessed serum cytokine levels in the cohort, and found that IL-1, IL-17 and IL-23 levels were higher in AS cases. Furthermore, among AS cases, IL-1 and IL-23 levels were increased in MEFV variant carriers compared with non-carriers. This study has therapeutic implications; as IL-1 inhibition is effective in FMF, AS cases carrying FMF-associated MEFV variants may benefit from such therapy.Item Does obesity affect treatment response to secukinumab and survival in ankylosing spondylitis? Real-life data from the TURKBIO RegistryKarakas, A; Gulle, S; Can, G; Dalkilic, E; Akar, S; Koca, SS; Pehlivan, Y; Senel, S; Tufan, A; Ozturk, MA; Yilmaz, S; Yazici, A; Cefle, A; Inel, TY; Erez, Y; Sari, I; Birlik, M; Direskeneli, H; Akkoc, N; Onen, FObjectives The aim of this study was to evaluate the impact of obesity on the treatment response to secukinumab and drug survival rate in patients with ankylosing spondylitis (AS). Methods We performed an observational cohort study that included AS patients based on the biological drug database in Turkey (TURKBIO) Registry between 2018 and 2021. The patients were divided into three groups: normal [body mass index (BMI) < 25 kg/m(2)], overweight (BMI: 25-30 kg/m(2)), and obese (BMI & GE; 30 kg/m(2)). Disease activity was evaluated at baseline, 3, 6, and 12 months. Drug retention rates at 12 months were also investigated. Results There were 166 AS patients using secukinumab (56.6% male, mean age: 44.9 & PLUSMN; 11.6 years). The median follow-up time was 17.2 (3-33.2) months. Forty-eight (28.9%) patients were obese. The mean age was higher in the obese group than in others (P = .003). There was no statistically significant difference in Bath Ankylosing Spondylitis Disease Activity Index 50, Assessment of SpondyloArthritis international Society 20 (ASAS20), ASAS40, Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity, and ASDAS clinically important improvement responses between the three groups at 3, 6, and 12 months, although they were numerically lower in obese patients. Drug retention rates at 12 months were similar in all groups (P > .05). Conclusions This study suggested that obesity did not affect secukinumab treatment response and drug retention in AS patients.Item DO COMORBIDITIES IMPACT PERSISTENCE OF FIRST TUMOR NECROSIS FACTOR INHIBITOR TREATMENT IN RHEUMATOID ARTHRITIS? DATA FROM TURKBIOInel, TY; Kocaer, SB; Erez, Y; Gulle, S; Karakas, A; Avsar, AK; Uslu, S; Can, G; Sari, I; Birlik, M; Dalkiliç, E; Pehlivan, Y; Akar, S; Goker, B; Cetin, GY; Haznedaroglu, S; Yavuz, S; Pirildar, T; Direskeneli, H; Akkoc, N; Onen, FItem Assessing rheumatologists' attitudes and utilization of classification criteria for ankylosing spondylitis and axial spondyloarthritis: a global effortRich-Garg, N; Danve, A; Choi, D; Vakil-Gilani, K; Akkoc, N; Azevedo, V; Russell, A; Sharma, A; Cush, J; Curtis, JR; Deodhar, AObjectives This study aims to assess rheumatologists' perceptions, utilization patterns, and attitudes towards the modified New York (mNY) criteria for ankylosing spondylitis (AS) and Assessment of SpondyloArthritis International Society (ASAS) criteria for axial spondyloarthritis (axSpA). Methods Members of the national rheumatology societies in five countries (United States of America (USA), Canada, India, Turkey, and Brazil) were invited to participate in a survey containing questions regarding rheumatologists' familiarity, and use of AS and axSpA classification criteria in daily practice, perceived specificity of spondyloarthritis features in making the diagnosis, patterns of imaging tests performed in daily practice, and their opinion about the need for modification of current classification criteria. The responses were analyzed by gender, age, years in practice, as well as by country of practice. Descriptive statistics,ttest, and chi-square test were used for comparison of groups. Results Approximately 6% rheumatologists (478 out of 8021 professional association members) from five countries completed the survey. The country-specific response rates were Brazil 4%, USA 4.3%, India 11%, Canada 14%, and Turkey 29%, though the overall contributions from individual countries were USA 47%, India 14.9%, Brazil 13.8%, Turkey 12.8%, and Canada 8.8%. The mean age of respondents was 50 years (+/- 11.8), 31% were females and 90% spent majority (> 75%) of their time in clinical practice. The mNY and ASAS criteria were regularly used in clinical practice by 44 and 66% of responders, respectively. Those reporting always using ASAS criteria were more likely to be women (p = 0.006), and within 5 years of completing rheumatology training. Vast majority (74%) regarded Inflammatory Back Pain (IBP) as a specific feature for axSpA. Majority (50 and 60%, respectively) regarded uveitis and dactylitis as very specific features helping them make the diagnosis of axSpA, whereas heel enthesitis, peripheral inflammatory arthritis, and response to NSAIDs were considered somewhat specific by 50% of the responders. Less than half (47%) of the responders used the mNY grading for X-ray of SI joints. In the case of normal X-ray of SI joint, the use of MRI was more frequent than CT scan (83.6 vs. 10.9%) in assessing for sacroiliitis. If sacroiliitis was not seen on X-rays, the likelihood of ordering MRI was significantly higher among rheumatologists completing training within < 15 years versus > 25 years prior (90 vs. 75%,p = 0.007). Overall, 70% thought that ASAS criteria were adequately specific for clinical trials. However, 42% respondents still felt a need to modify ASAS classification criteria for axSpA. Also, 46% respondents felt that mNY criteria should be modified. Conclusions In the absence of diagnostic criteria, majority of rheumatologists are using the classification criteria for diagnosis of axSpA. Though axSpA classification criteria are perceived to be specific for clinical trials, 40% rheumatologists feel the need to modify these criteria.Item GENETIC SUSCEPTIBILITY AND PHENOTYPE OF RHEUMATOID ARTHRITIS IN DANISH AND TURKISH PATIENTSLauridsen, KB; Linauskas, A; Rasmussen, C; Can, G; Onen, F; Dreyer, L; Steffensen, R; Nielsen, KR; Krogh, NS; Akar, S; Akkoc, NItem DO COMORBIDITIES DECREASE THE FIRST TNF-INHIBITOR RETENTION AND TREATMENT RESPONSE IN AXIAL SPONDYLOARTHRITIS PATIENTS? DATA FROM TURKBIOErez, Y; Karakas, A; Kocaer, SB; Inel, TY; Gulle, S; Avsar, AK; Uslu, S; Can, G; Sari, I; Birlik, M; Dalkiliç, E; Pehlivan, Y; Senel, S; Akar, S; Koca, SS; Tufan, A; Yazici, A; Yilmaz, S; Inanc, N; Solmaz, D; Akkoc, N; Onen, FItem Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritisKiltz, U; Landewé, RBM; van der Heijde, D; Rudwaleit, M; Weisman, MH; Akkoc, N; Boonen, A; Brandt, J; Carron, P; Dougados, M; Gossec, L; Jongkees, M; Machado, PM; Marzo-Ortega, H; Molto, A; Navarro-Compán, V; Niederman, K; Sampaio-Barros, PD; Slobodin, G; van den Bosch, FE; van Tubergen, A; van Weely, S; Wiek, D; Braun, JObjectives The Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial spondyloarthritis (axSpA) worldwide. Methods An ASAS task force developed a set of QS using a stepwise approach. First, key areas for quality improvement were identified, discussed, rated and agreed on. Thereafter, areas were prioritised and statements for the most important key areas were phrased on consensus. Appropriate quality measures were defined to allow quantification of the QS at the community level. Results The ASAS task force, consisting of 20 rheumatologists, two physiotherapists and two patients, selected and proposed 34 potential key areas for quality improvement which were then commented by 140 ASAS members and patients. Within that process three new key areas came up, which led to a re-evaluation of all 37 key areas by 120 ASAS members and patients. Five key areas were identified as most important to determine quality of care: referral including rapid access, rheumatology assessment, treatment, education/self-management and comorbidities. Finally, nine QS were agreed on and endorsed by the whole ASAS membership. Conclusions ASAS successfully developed the first set of QS to help improving healthcare for adult patients with axSpA. Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for.Item The impact of a csDMARD in combination with a TNF inhibitor on drug retention and clinical remission in axial spondyloarthritisNissen, M; Delcoigne, B; Di Giuseppe, D; Jacobsson, L; Hetland, ML; Ciurea, A; Nekvindova, L; Iannone, F; Akkoc, N; Sokka-Isler, T; Fagerli, KM; Santos, MJ; Codreanu, C; Pombo-Suarez, M; Rotar, Z; Gudbjornsson, B; Van der Horst-Bruinsma, I; Loft, AG; Möller, B; Mann, H; Conti, F; Cetin, GY; Relas, H; Michelsen, B; Ribeiro, PA; Ionescu, R; Sanchez-Piedra, C; Tomsic, M; Geirsson, AJ; Askling, J; Glintborg, B; Lindström, UObjectives Many axial spondylarthritis (axSpA) patients receive a conventional synthetic DMARD (csDMARD) in combination with a TNF inhibitor (TNFi). However, the value of this co-therapy remains unclear. The objectives were to describe the characteristics of axSpA patients initiating a first TNFi as monotherapy compared with co-therapy with csDMARD, to compare one-year TNFi retention and remission rates, and to explore the impact of peripheral arthritis. Methods Data was collected from 13 European registries. One-year outcomes included TNFi retention and hazard ratios (HR) for discontinuation with 95% CIs. Logistic regression was performed with adjusted odds ratios (OR) of achieving remission (Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP < 1.3 and/or BASDAI < 2) and stratified by treatment. Inter-registry heterogeneity was assessed using random-effect meta-analyses, combined results were presented when heterogeneity was not significant. Peripheral arthritis was defined as >= 1 swollen joint at baseline (=TNFi start). Results Amongst 24 171 axSpA patients, 32% received csDMARD co-therapy (range across countries: 13.5% to 71.2%). The co-therapy group had more baseline peripheral arthritis and higher CRP than the monotherapy group. One-year TNFi-retention rates (95% CI): 79% (78, 79%) for TNFi monotherapy vs 82% (81, 83%) with co-therapy (P < 0.001). Remission was obtained in 20% on monotherapy and 22% on co-therapy (P < 0.001); adjusted OR of 1.16 (1.07, 1.25). Remission rates at 12 months were similar in patients with/without peripheral arthritis. Conclusion This large European study of axial SpA patients showed similar one-year treatment outcomes for TNFi monotherapy and csDMARD co-therapy, although considerable heterogeneity across countries limited the identification of certain subgroups (e.g. peripheral arthritis) that may benefit from co-therapy.Item European bio-naive spondyloarthritis patients initiating TNF inhibitor: time trends in baseline characteristics, treatment retention and responseChristiansen, SN; Ornbjerg, LM; Rasmussen, SH; Loft, AG; Askling, J; Iannone, F; Zavada, J; Michelsen, B; Nissen, M; Onen, F; Santos, MJ; Pombo-Suarez, M; Relas, H; Macfarlane, GJ; Tomsic, M; Codreanu, C; Gudbjornsson, B; Van der Horst-Bruinsma, I; Di Giuseppe, D; Glintborg, B; Gremese, E; Pavelka, K; Kristianslund, EK; Ciurea, A; Akkoc, N; Barcelos, A; Sánchez-Piedra, C; Peltomaa, R; Jones, GT; Rotar, Z; Ionescu, R; Grondal, G; Van de Sande, MGH; Laas, K; Ostergaard, M; Hetland, MLObjectives To investigate time trends in baseline characteristics and retention, remission and response rates in bio-naive axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) patients initiating TNF inhibitor (TNFi) treatment. Methods Prospectively collected data on bio-naive axSpA and PsA patients from routine care in 15 European countries were pooled. Three cohorts were defined according to year of TNFi initiation: A (1999-2008), B (2009-2014) and C (2015-2018). Retention, remission and response rates were assessed at 6, 12 and 24 months. Results In total, 27 149 axSpA and 17 446 PsA patients were included. Cohort A patients had longer disease duration compared with B and C. In axSpA, cohort A had the largest proportion of male and HLA-B27 positive patients. In PsA, baseline disease activity was highest in cohort A. Retention rates in axSpA/PsA were highest in cohort A and differed only slightly between B and C. For all cohorts, disease activity decreased markedly from 0 to 6 months. In axSpA, disease activity at 24 months was highest in cohort A, where also remission and response rates were lowest. In PsA, remission rates at 6 and 12 months tended to be lowest in cohort A. Response rates were at all time points comparable across cohorts, and less between-cohort disease activity differences were seen at 24 months. Conclusion Our findings indicate that over the past decades, clinicians have implemented more aggressive treatment strategies in spondyloarthritis. This was illustrated by shorter disease duration at treatment initiation, decreased retention rates and higher remission rates during recent years.