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IntroductionOur objectives were to assess the frequency and sustainability of American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) and Disease Activity Score (DAS)28(4v)–C-reactive protein (CRP) remission 12 months after the initiation of tumour necrosis factor inhibitor (TNFi) therapy in a rheumatoid arthritis (RA) cohort.MethodsData were collected of 273 biologic naive RA patients at baseline, then 3, 6 and 12 months post-TNFi therapy. Remission status was calculated using DAS28(4v)-CRP <2.6 and ACR/EULAR Boolean criteria. Response was scored using EULAR criteria.ResultsMean (range) patient age was 59.9 (7.2-85.4) years with disease duration of 13.4 (1.0-52.0) years. Responder status maintained from 3–12 months (86%, 82.4%), laboratory/clinical parameters (erythrocyte sedimentation rate (ESR), CRP, patient global health (PGH), DAS28(4v)-CRP) also showed sustained improvement (P < 0.05). DAS28 remission was reached by 102 subjects at 1 year, 27 patients were in Boolean remission, but 75 missed it from the DAS28 remission group. Patients in remission were younger (P = 0.041) with lower baseline tender joint count (TJC)28 and PGH than those not in remission (P = 0.001, P = 0.047). DAS28 remission patients were older (P = 0.026) with higher 12 months PGH and subsequently higher DAS28 than Boolean remission patients (P < 0.0001). Patients not achieving Boolean remission due to missing one subcriteria most frequently missed PGH ≤1 criteria (79.8%).ConclusionsOnly 10% of this TNFi treated cohort achieved remission according to the new ACR/EULAR criteria, which requires lower disease activity. More stringent criteria may ensure further resolution of disease activity and better longterm radiographic outcome, which supports earlier intervention with biologic therapy in RA.

Purpose: The 10-diopter (D) fixation test is a useful test for detecting amblyopia in children without a manifest deviation and in whom 3 reliable visual acuity assessment is difficult. The 1 0 prism diopter is conventionally placed base down. Methods: Seventeen children were studied over a 12-month period to determine the effect of prism orientation on the accuracy of the 10-D fixation test in children with unilateral ptosis. Results: Anomalous results were obtained in 4 of ? 7 patients with the prism held base up and base down. Conclusions: To prevent an erroneous diagnosis of amblyopia in children with unilateral ptosis, the prism should be held base up when performing the 1 0-D fixation test. Journal of Pediatric Ophthalmology and Strabismus 2000;37:21-23.

Background Early diagnosis and remission-oriented treatment are essential to achieve good outcomes in rheumatoid arthritis (RA). New RA remission criteria have been developed by American College of Rheumatology/The European League Against Rheumatism (ACR/EULAR) in 2011. Objectives Remission rates of tumor necrosis factor inhibitor (TNFi) treated RA patients were compared using ACR/EULAR and DAS28-4 variable-CRP (DAS28(4v)-CRP) remission criteria. Methods Clinical and laboratory data were collected prospectively of 273 biologic naive RA patients commencing TNFi therapy at 0, 3, 6, 12 months. Remission status was calculated at all timepoints using ACR/EULAR Boolean and DAS28(4v)-CRP <2.6 remission criteria. Response was scored using EULAR response criteria. Statistics were made using SPSS v20. Results Mean (range) patient age was 59.9 (7.2-85.4) years with disease duration of 13.4 (1.0-52.0) years. In total 86% of patients were responders (37% good; 50% moderate) at 3 months and maintained, with a further increase, at 12 months (51% good; 32% moderate). Laboratory and clinical parameters (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), patient global health (PGH), DAS28(4v)-CRP showed significant sustained improvement at 3 and 12 months of therapy (p<0.05). Over half of patients (54.9%) had disease activity of DAS28(4v)-CRP<3.2 at 12 months. All patients in Boolean remission were in DAS28 remission at all timepoints. 102 patients (37%) were in any remission at 12 months: 75 (27%) in DAS28 remission alone and 27 (10%) in both Boolean and DAS28 remission. We further compared remsission statuses at one year. All patients in any remission were significantly younger (p=0.041) with lower baseline tender joint count 28 (TJC28) and patient global health (PGH) scores than those not in remission (p=0.001, p=0.047). Boolean-remission patients were younger (p=0.026) and had lower 12 months DAS28 and PGH (all p<0.0001). Disease activity of the most active Boolean remission patient was found to be 1.97 calculated by DAS28(4v)-CRP. Patients not achieving Boolean remission due to missing just one Boolean subcriteria being ≤1 (30.77 %), most frequently missed PGH ≤1 criteria (76.2 %). Conclusions Only 10% of this TNFi treated RA cohort achieved remission according to the new ACR/EULAR criteria, which originally requires lower disease activity state for remission. Failing Boolean remission due to the lack of one subcriteria was often resulted by primarily higher PGH values. This may reflect a delay in initiating biologic therapy and support earlier, more aggressive therapy in RA. References Rheumatoid arthritis disease activity measures: American College of Rheumatology recommendations for use in clinical practice. Anderson J et al. Arthritis Care Res (Hoboken). 2012 May;64(5):640-7. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Felson DTet al.; American College of Rheumatology; European League Against ...

Background 68 tender (TJC) and 66 swollen joint counts (SJC) are recommended for disease activity assessment in psoriatic arthritis (PsA). However there are time constraints and these counts may not be performed. It has been shown in rheumatoid arthritis that patient's self-reported joint counts correlate well with functional disability, pain and global disease severity. Information concerning patients' self-assessed joint counts however is limited in PsA. Objectives The aim of this study is to evaluate the reliability of patient self-assessed joint counts versus joint counts obtained by a physician, a nurse and B-mode ultrasonography (US) in PsA. Methods PsA patients fulfilling the CASPAR criteria were recruited. Following a training session on the detection of tender and swollen joints by a nurse, each patient assessed their 68 joints using an electronic digital mannequin on touchscreen. A joint examination by a different nurse and a rheumatologist, both blinded to the patients' clinical data was completed. US evaluation was performed by a further consultant rheumatologist on 34 joints assessing wrists, MCPs and PIPs, ankles and MTPs, and all extensor/flexor tendons of the fingers and toes. Presence of joint effusion, synovial proliferation and tenosynovitis on grayscale (GS); and synovitis/tenosynovitis on power Doppler (PD) signal were evaluated. Results 43 patients (29 female and 14 male) were enrolled to the study with a mean age of 51 (±13.5) years. Focusing on the 34 joints also assessed by US, mean TJC assessed by the patients, physician and nurse was 9 (±8.3), 7 (±7.4) and 7 (±6.9), mean SJC was 4 (±5.6), 1 (±1.8) and 3 (±3.2) respectively. Mean number of affected (swollen or tender) joints as per patient, physician, nurse and US evaluation was 10 (±8.2), 7 (±7.1), 8 (±7) and 6 (±4.4), respectively. Patient and nurse-assessed SJC was significantly higher than physician-counts (p=0.0007; p=0.013, respectively). The number of affected joints was higher as evaluated by patients compared to physicians and US (p=0.019; p=0.012, respectively). Joint effusion was detected by US in 72%, synovitis in 79% on GS and 70% on PD and 30% of the patients had tenosynovitis. TJC and the number of affected joints did not correlate significantly with any of the US measurements irrespective of the assessors. Patients SJC significantly correlated with US-assessed joint effusion, and with synovitis (GS and PD). Physician and nurse-reported SJC correlated with US-derived synovitis scores only. Conclusions Patients scored their SJC and number of affected joints higher than physicians and US measurements. Patient-reported SJC correlated with both effusion and synovitis as detected by US suggesting that patients' self-evaluated SJC may be valid in routine clinical practice for monitoring disease activity in PsA. Disclosure of Interest A. Szentpetery: None declared, M. Haroon: None declared, E. O'Flynn: None declared, P. Gallagher: None declared, S. Alraqi: None declared, O. FitzGerald Grant/research support: Pfizer, Ab...