BackgroundGroup 2 innate lymphoid cells (ILC2s) were closely associated with asthma. However, there were no perspective studies about the effects of glucocorticoid on ILC2s in asthma patients. Our objective was to perform a perspective study and evaluate the ILC2 activity after glucocorticoid therapy in asthma patients.MethodsThe asthma and asthma with allergic rhinitis patients were treated with glucocorticoid for 3 months. The circulating ILC2 levels were evaluated. The effects of glucocorticoid on ILC2s and possible signalling pathways were investigated in vitro.ResultsThe patients were well‐controlled, and the high ILC2 levels were significantly decreased at 1 and 3 months after treatment. Peripheral blood monocytes from allergic patients produced dramatic IL‐5, IL‐13 and IL‐9 in response to IL‐25, IL‐33 plus IL‐2, and glucocorticoid significantly decreased their levels. Moreover, ILC2s were identified to be the predominant source of IL‐5, IL‐13 and IL‐9, and glucocorticoid treatment was able to reverse their high levels. STAT3, STAT5, STAT6, JAK3 and MEK signalling pathways were proved to be involved in regulating ILC2 activity under the glucocorticoid treatment.ConclusionThe data suggested that glucocorticoid administration could be effective in treating asthma by regulating ILC2s via MEK/JAK‐STAT signalling pathways. This provides a new understanding of glucocorticoid application in regard to allergic diseases.

Background: Treatment of chronic wounds using traditional surgical procedures is challenging because of the low graft take rates. This study investigated the combination approach of split-thickness autografts with harvested skin cell suspension for chronic wound treatment. Click here to watch video footage recorded by the author about the contents of this paper.

Background Mycophenolate mofetil (MMF) and azathioprine (Aza) has long been used as maintenance immunosuppressive treatment for lupus nephritis. However, the benefits of MMF was limited by its high cost in China. Unpredictable severe pancytopenia induced by Aza is not common but may be fetal. Optimal therapeutic modalities with more cost-effectiveness and safety were required to be identified and thus modify the immunotherapeutic strategies. Tripterygium wilfordii multiglycoside (GTW), an authorized Chinese patent drug, has been used for the treatment of autoimmune diseases for decades in China[1]. We retrospectively reviewed 326 patients with proliferative lupus nephritis who received MMF, Aza or GTW as long-term maintenance agents in this study, compared the efficacy among these three groups and observed side effects of the medication. Objectives To evaluate the outcome and side effects of Tripterygium wilfordii multiglycoside as long-term maintenance therapy in the treatment of systemic lupus erythematosus. Methods We retrospectively reviewed 326 patients with proliferative lupus nephritis between 2000 and 2006 in south China who received MMF, Aza or Tripterygium wilfordii multiglycoside as maintenance regimen. After a short course of intravenous cyclophophamide as induction therapy according to the NIH protocol, MMF (target dose: 2 g/day), AZA (target dose: 2 mg/kg/day) or GTW (target dose: 1.8 g/day) was administrated. Steroids and antimalarial drugs were continued if necessary. The patients were followed up till October 2011. Details of the clinical presentation (renal remission, disease remission, the occurrence of renal relapse, chronic renal failure and death, etc), serological, immunological variables and side effects were collected. Results No significance of demographic variables was found among MMF group (115 cases), Aza group (91 cases) and GTW group (120 cases). Significant renal parameter improvements were observed in all patients after induction therapy. GTW group had a similar probability of remaining remission and renal function improvement or stabilization in five years to AZA group (77% in GTW group and 74% in AZA group). Time to severe systemic flare, benign flare and glucosteroid withdrawal were similar between the two groups. MMF was superior to GTW and AZA (87% in MMF group). Skin and joint involvements were best controlled in GTW group. Drug related toxicities were similar except that cytopenias were more common in AZA group. Conclusions GTW was as effective as AZA in the long-term maintenance treatment of proliferative lupus nephritis. Fewer renal flares were identified in the patients received MMF. GTW was a reasonable consideration for patients unwilling to take MMF. Promising toxicity profile was observed in GTW. References Comparison of toxic reaction of Tripterygium wilfordii multiglycoside in normal and adjuvant arthritic rats. J Ethnopharmacol. 2011; 135 (2): 270-7. Disclosure of Interest None Declared

Objectives Infections commonly complicate the course of systemic lupus erythematosus (SLE). Our aim is to investigate the clinical features and potential clinical predictors of infections in patients with SLE. Methods A retrospective cohort study was performed among patients admitted to the First Affiliated Hospital of Sun Yet-sen University from January 2007 to June 2012. Demographic information, clinical and laboratory data and pathogen were collected. Univariate analysis and logistic regression models were used for the analysis of data. Results Among 2568 patients included, 1321 (51.44%) were diagnosed with infection, with the average age of 34.97±13.22 years old and the mean duration of SLE was 44.65±65.19 months (range 1-480 months). 1452 infections involving various microorganisms were recorded. Bacterial infection was predominant (49.66%), followed by viral infection (39.12%), fungal infection (7.30%) and Mycobacterium (3.93%) infections. The pulmonary was most commonly affected (37.81%). Less common sites of infection included upper respiratory tract, genitourinary tract, skin/soft tissue and so on. The most frequently found bacteria were Escherichia coli (26.63%), followed by Acinetobacter baumannii (13.43%) and Staphylococcus aureus (11.19%). 32.84% of the isolated bacteria were multi-drug resistant. Herpes zoster was the most common viral infection. The most common fungus was Candida albicans (74 episodes), followed by Candida tropicalis (8 episodes) and Candida glabrata (8 episodes). The mortality (1.74% vs. 0.80%, respectively) and average length of stay (19.88±14.84 days vs. 15.54±9.33 days, respectively) in patients with infection were both significantly higher than those in the patients without infection. The logistic regression multivariate analysis indicated that higher SLEDAI (OR=1.02, 95% CI: 1.00-1.03), lung disease (OR=1.80, 95%CI: 1.16-2.79),nephritis (OR=1.71, 95%CI: 1.45-2.21), anemia (OR=1.38, 95%: 1.13-1.69), elevated CRP (OR=1.04, 95% CI: 1.04-1.05) and treatment with higher dose cyclophosphamide (CYC) (≥1.0 g/m2/month) (OR=2.94,95%CI: 2.24-3.87) were positively associated with the occurrence of infections. Conclusions Infections were common in SLE patients, which increased both the mortality and average length of stay. The current study demonstrated that higher SLEDAI, lung disease, nephritis, anemia, elevated CRP and treatment with higher dose CYC were associated with the infection. It is concluded that a high level of suspicion and close monitoring of SLE patients with risk factors may ensure an optimal outcome. The judicious use of CYC is critical in limiting infections in SLE patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3052

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BackgroundCompared with the general population, patients with lupus nephritis (LN) are still at high risk of adverse pregnancy outcomes (APOs), including fetal loss, preterm birth and intrauterine growth retardation (IUGR). Umbilical artery is particularly important for placental perfusion and fetal development. Increased umbilical artery resistance could be traced by Doppler velocimetry, which could be used as a screening tool for placenta-related diseases. However, the predictive value in HDP of lupus pregnancies has not been widely assessed.ObjectivesTo examine the predictive value of the fetal umbilical artery Doppler on adverse pregnancy outcomes (APOs) in pregnant women with lupus nephritis (LN).MethodsThe clinical data of 158 LN pregnant patients from the First Affiliated Hospital of Sun Yat-sen University were analysed retrospectively.ResultsTotally, 119 were diagnosed before pregnancy and 39 were newly diagnosed during pregnancy. One or more APOs occurred in 74.7% of patients with LN and 40 (25.3%) were without any APOs. Fifty-four of pregnancies (12.2%) resulted in fetal loss. A total of 55 pregnancies were preterm birth, 24 were IUGR, 14 were fetal distress and 9 were neonatal lupus. Doppler pulsatility index (PI), resistance index (RI) as well as S/D value were significantly higher in the APOs groups than in the patients without APOs (p<0.05). The area below the receiver operating characteristic (ROC) curve for PI, RI and S/D all was 0.7 (95%CI 0.6~0.8). PI with cut-off value of 0.9 indicated the highest risk of APOs, with sensitivity of 28.3% and specificity of 97.2%. Regarding 0.6 as the cut-off value for RI to predict APOs, the sensitivity was 45.7% and the specificity was 80.6%. The optimal cut-off value for S/D was 2.5, at which sensitivity (39.1%) and specificity (90.0%) had the best combination.ConclusionsPregnancies in LN were more prone to pregnancy loss and preterm birth. Umbilical artery Doppler was a useful monitoring measure for APOs in pregnancies of LN.Disclosure of InterestNone declared

Background Long-term use of traditional and biologic disease-modifying anti-rheumatic drugs (DMARDs) has been applied to achieve the goal of rheumatoid arthritis (RA) treatment. Despite the proven efficacy of DMARDs, there is concern of increased risk of side effects in the long-term therapy. DMARD sparing agents with lower toxicity were required to be identified for modification of the therapeutic strategies. Tripterygium wilfordii multiglycoside (GTW), an authorized Chinese patent drug, has been used for the treatment of autoimmune diseases for decades in China[1]. We retrospectively reviewed 268 RA patients treated with GTW combined DMARDs or DMARDs without GTW for maintenance therapy, compared the efficacy, observed side effects and preliminarily explore the dose reduction or discontinuation protocol of some label DMARDs. Objectives To evaluate the efficacy and safety of Tripterygium wilfordii multiglycoside combined therapy as long-term maintenance therapy in the treatment of rheumatoid arthritis. Methods We retrospectively reviewed 268 patients with rheumatoid arthritis between 2006 and 2008 in south China who received MTX, etanercept, or GTW combined MTX/etanercept regimens as maintenance therapy. After a standard treatment to target based on MTX or MTX in combination with etanercept as induction therapy, GTW (target dose: 1.8 g/day) were given to the patients with sufficient response to baseline DMARDs. Baseline MTX and/or etanercept was continued for another three months after remission, then stepped down every three months until discontinuation of etanercept and half of the MTX dose at the onset. The patients were followed up for 3 years. Details of the clinical presentation, serological, immunological variables and side effects were collected. Results In patients receiving maintenance therapy with combined GTW, disease activity score (DAS28) and x-ray changes were similar to the patients receiving usual treatment. More than half of the patients treated with combined GTW had no radiographic progression over 3 years, compared with those treated with usual dose of MTX and/or etanercept (63.4% vs 69.6%; p>0.05). Improvements in laboratory measurements and physical functions were comparable. Drug related toxicities including abnormal liver function, infection and gastrointestinal intolerance, etc were significantly lower in GTW group. Conclusions GTW was a well tolerated and effective DMARD sparing agents in the maintenance therapy of rheumatoid arthritis. Concomitant GTW decreased the exposure to MTX and etanercept, thus reduced the correlative side effects. References Comparison of toxic reaction of Tripterygium wilfordii multiglycoside in normal and adjuvant arthritic rats. J Ethnopharmacol. 2011; 135 (2): 270-7. Disclosure of Interest None Declared

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