Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey.The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods.Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode.These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.
Confirmation of anatomical reduction of ankle syndesmosis is mandatory because improper reduction leads to poor functional results. Coronal plane evaluation of syndesmosis is well described in the literature, but there is little information about sagittal plane evaluation. We sought to evaluate the relationship of fibula and tibia in the sagittal plane and create a new reference that can be applied easily and reliably.Lateral ankle radiographs of 337 individuals with no history of ankle fracture were evaluated. A line was drawn between the anterior and posterior cortices of the distal lateral tibia, and the length of this line was measured (line 1). The distance between the anterior and posterior cortices of the fibula on this line was measured, and the center of this second distance was identified and marked. The posterior half of the fibular width was divided by line 1 and was named the lateral posterior ankle ratio (LPAR). Statistical analysis was performed by side and sex.Mean patient age was 38.6 years; mean LPAR was 0.48. There was a significant difference between men and women by age (P < .001) and LPAR (P = .01). There was no significant difference between right and left ankles by age (P = .63) and LPAR (P = .64). The LPAR was less than 0.40 in 6.8% of the radiographs, 0.40 to 0.50 in 57.9%, and greater than 0.50 to 0.60 in 32.9%.The LPAR should approximate 50% in normal lateral ankle images and, by extrapolation, after syndesmotic reduction.
Adult onset Still's disease (AOSD) is a rare, auto-inflammatory disease that commonly presents as fever of unknown origin (FUO), and most common rheumatologic cause of FUO. Clinical and/or laboratory parameters that can discriminate AOSD from other causes of FUO need to be clarified in current literature.
Objectives
To determine clinical and/or laboratory parameters that help to differentiate AOSD from other causes of FUO and demonstrating a clinician-friendly algorithm for this purpose.
Methods
Data from patients who admitted to Hacettepe University Hospitals, inpatients sections of department of internal medicine with the complaint of FUO, who eventually had a certain diagnosis, collected prospectively during 30 months. AOSD patients followed at Hacettepe University department of rheumatology were included. Clinical and laboratory data were collected at the time of diagnosis of AOSD and time of admission of patients with FUO.
Results
Total 156 patients (n=69, for AOSD; n=87, for FUO) were included. FUO group were also divided into three subgroups: rheumatologic (n=31, 35.6%), infectious (n=28, 32.2%) and malignant (n=28, 32.2%) causes. While 51 (74%) patients were female in AOSD group, 43 (49,4%) patients were female in FUO group (p=0.03). Frequency of rash, arthralgia, arthritis, sore throat, fever at night (p<0.001 for each), history of hemophagocytosis (p=0.037) were significantly higher in AOSD group. Fever peak number equal and/or higher than 3, presence of lymphadenopathy (p=0002 and p=0,001,respectively) were significantly higher in FUO group. While leukocytosis, neutrophilia, thrombocytosis, hyperferritinemia, higher lactate dehydrogenase and complement 3 levels (p<0.001 for each) were significantly more frequent in AOSD group, albumin levels lower than 3 g/dl and positive rheumatoid factor (p=0.009 and p=0.002,respectively) were significantly more frequent in FUO group. Results of univariate and multivariate analysis are given in table 1. Algorithm for discrimination of AOSD and FUO is given at Abstract SAT0608 – figure 1.
Conclusions
Presence of arthralgia, hyperferritinemia, sore throat and neutrophilia strongly favour AOSD in patients presenting as FUO. This study demonstrates a clinician-friendly algorithm for the first time in current literature.
Background: For inflammatory arthritis, drug retention is accepted as an important indicator of the effectiveness and safety of biological drugs. Objectives: The objective of this study was to determine of the effects first and overall bDMARD drug retention rate during concomitant csDMARD in psoriatic arthritis (PsA). Methods: HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a prospective, single center database of biological treatments since 2005. All PsA patients (469) who enrolled in HUR-BIO registry and prescribed at least once biologic DMARD (bDMARD) were included in the study. The subjects were divided into two groups depending on whether or not to use csDMARDs (methotrexate, sulphasalazine or leflunomide) at the last control visit. Demographic, clinical and therapeutic data were collected from this database. Baseline disease activity before the first bDMARD initiation was assessed with DAPSA and PsAID-12. Table. Demographics, baseline and follow-up clinical characteristics of PsA patients With concomitant csDMARD n=288 Without concomitant csDMARD n=167 p Age (mean, SD) 48.9 (12.1) 45.1 (12.4) 0.002 Female n (%) 204 (70.8) 113 (67.7) 0.48 PsA disease duration (med, IQR) 7 (13) 7 (14.5) 0.53 Age at PsA diagnosis (mean, SD) 39 (11.7) 40.8 (12.9) 0.81 BMI (mean, SD) 29.6 (6.0) 29.2 (5.9) 0.53 Axial involvement n (%) 68 (34.0) 37 (44.6) 0.09 HLA-B 27 (+) n (%) 21/76 (27.6) 17/69 (24.6) 0.68 Duration of use first bDMARD (months) (med, IQR) 22.4 (51.3) 14.1 (31.4) 0.003 Duration of use overall bDMARD (months) (med, IQR) 56.8 (69.4) 24.4 (57.7) <0.001 Switching bDMARD (+) n (%) 148 (52.5) 71 (42.8) 0.04 Initial DAPSA 1 (med, IQR) 19.4 (11.7) 17.3 (10.2) 0.04 Initial PSAID 2 (med, IQR) 5.7 (3) 5.6 (2.8) 0.55 Final visit PSAID 3 (med, IQR) 2.8 (3.8) 2 (5.7) 0.41 Final visit DAPSA 4 (med, IQR) Remission (n,%) Low disease activity Moderate disease activity High disease activity 10.2 (12.4) 12.5 (12.5) 0.01 Remission (n,%) 61 (23.9) 111 (43.5) 72 (28.2) 11 (4.3) 27 (17.6) 59 (38.6) 58 (37.9) 9 (5.9) 0.13 Low disease activity 111 (43.5) 59 (38.6) Moderate disease activity 72 (28.2) 58 (37.9) High disease activity 11 (4.3) 9 (5.9) 1 : n=249, 2 : n=214, 3 : n=109, 4 : n=408 p<0.001 p=0.003 Results: HUR-BIO PsA registry included 469 PsA patients. Baseline, clinical characteristics and follow-up parameters were given in Table. The using overall bDMARD were adalimumab 294 (62.0%), etanercept 135 (28.8%), infliximab 119 (25.4%), certolizumab pegol 107 (22.8%), secukinumab 67 (14.3%), golimumab 58 (12.4%), ustekinumab 25 (5.3%) and tofacitinib 11 (2.3%). Two hundred eighty eight (61.4%) patients used concomitant cDMARDs [methotrexate 176 (37.5%), leflunomide 94 (20.0%), sulphasalazine 35 (7.5%) and two csDMARD combination 17 (3.6%)]. The first-year retention rate of first bDMARD with or without concomitant csDMARDs were 88% and 80%, respectively. The median duration of first bDMARD retention with or without concomitant csDMARDs were 131.7 and 91.4 months, respectively (Figure). The first-year retention rate of overall bDMARDs with or without concomitant csDMARDs were 92% and 85%, respectively. The median drug retention rate of overall bDMARD in using csDMARD and not using csDMARD were 141.5 and 131.5 months, respectively. Retention rates (both for first bDMARD and overall bDMARDs) were significantly higher in concomitant csDMARDs using group (p=0.003 for first bDMARD retention, p<0.001 for overall bDMARDs retention, log-rank; Figure). In concomitant csDMARD using group, no differences were identified methotrexate or other csDMARDs. Conclusion: In this study, csDMARDs, either methotrexate or leflunomide/sulphasalazine have additional effect for both retention rate and treatment response of bDMARDs. On the other hand, using bDMARD monotherapy is relatively higher than rheumatoid artritis (1). Figure. Drug retention rate of the first bDMARD and overall bDMARDs according to concomitant csDMARD use ( csDMARD:conventional synthetic Disease Modifiying Antirheumatic Drug ) Disclosure of Interests: Emine Duran: None declared, Emre Bilgin: None declared, Ertugrul Cagri Bolek: None declared, Gözde Kübra Yardimci: None declared, Bayram Farisoğullari: None declared, Levent Kiliç: None declared, Ali Akdoğan: None declared, Omer Karadag: None declared, Şule Arpaş Bilgen: None declared, Sedat Kiraz: None declared, Ali İhsan Ertenli: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB
Objectives: Psoriatic arthritis is a chronic musculoskeletal disorder which may affect skin, joints, bone and enthesis. Conventional synthetic disease modifying anti-rheumatic drugs are first-line treatment options and biologic disease modifying anti-rheumatic drugs are recommended in psoriatic arthritis patients who are intolerant/not controlled well with conventional synthetic disease modifying anti-rheumatic drugs. Although survival data of the conventional synthetic disease modifying anti-rheumatic drugs without concomitant biologic disease modifying anti-rheumatic drugs are available, the effect of biologic disease modifying anti-rheumatic drugs on the retention of conventional synthetic disease modifying anti-rheumatic drugs is still a question of interest.
Materials and Methods: Psoriatic arthritis patients who received at least 1 dose of biologic disease modifying anti-rheumatic drugs, using at least 1 conventional synthetic disease modifying anti-rheumatic drugs (methotrexate, leflunomide, hydroxychloroquine and sulfasalazine) at the time of biologic disease modifying anti-rheumatic drugs starting visit and registered in the Hacettepe University BIOlogical Database-Psoriatic Arthritis were included in this retrospective longitudinal analysis. Demographic and disease-specific data at first and last follow-up visit were collected. Unadjusted retention rate of each conventional synthetic disease modifying anti-rheumatic drugs was assessed. Overall prescription of conventional synthetic disease modifying anti-rheumatic drugs at first and last follow-up visit were compared.
Results: A total of 266 (191(71.8%) female) patients was included. Median follow-up duration under biologic treatment was 43.4 (19.4-80.1) months. Median retention duration of each conventional synthetic disease modifying anti-rheumatic drugs were similar. Between the first and last visit; there was a 29.3% decrease in methotrexate use (61.7% vs. 43.6%; p<0.001), 8.4% decrease in leflunomide use (31.2% vs. 28.6%; p=0.30), 30.0% decrease in sulfasalazine use (11.3% vs. 7.9%; p=0.05), 31.1% decrease in hydroxychloroquine use (16.9% vs. 11.7%; p=0.001), 12.5 % decrease in glucocorticoids use (51.1% vs. 44.7%; p=0.015). At last visit, 59 (22.2%) patients were conventional synthetic disease modifying anti-rheumatic drugs -free: 20 (7.5%) patients were using only glucocorticoids, 39 (14.7%) patients were conventional synthetic disease modifying anti-rheumatic drugs + glucocorticoid-free.
Conclusion: Although conventional synthetic disease modifying anti-rheumatic drugs were significantly discontinued in an important percent of patients after the initiation of biologic disease modifying anti-rheumatic drugs, percentage of patients using glucocorticoids at last visit was still high. Studies aiming to demonstrate when, in whom and how to discontinue conventional synthetic disease modifying anti-rheumatic drugs are needed.
