Background It has been stated that rheumatoid arthritis (RA) and fibromyalgia (FM) can simultaneously affect patients. At the same time DAS28 values tend to be higher in RA patients whom have also developed FM and this might cause a more aggressive therapeutic approach and further misinterpretation of the clinical outcome in this group of patients. Objectives To study the effect and beneficial outcome of remissive therapy in a Romanian RA cohort diagnosed with concomitant FM Methods The initial group included 34 established RA female patients with a disease duration of minimum 12 months (diagnosed between 2006-2008) and a mean age of 41.3±4 years which were also diagnosed with FM within 3 to 6 months prior to inclusion. A second group consisting of 20 RA female patients with no clinical signs of FM was chosen as controls. All patients were started on a stable Methotrexate dose of 7.5-15mg/week for the first 12 weeks. Both groups were evaluated every 3 to 6 months between 2009-2011 through the Disease Activity Score on 28 joints (DAS284v) Results The first group showed little if no DAS28 improvement with a mean value of 5.1±0.7 (p<0.001) after 3 months of MTX therapy leading towards dosage increasing while the controls showed a mean value of 4.2±0.5 (p<0.001) thus avoiding dosage adjustments. After the second evaluation point at 6 months, 7 out of the initial 34 patients included in the study group needed a higher MTX dosage showing a mean value of DAS28 of 4.5. After the first 12 months 11 patients from the study group and 3 controls were administered a different remissive therapeutic agent due to their disease activity score – a mean value of DAS28 of 4.8±0.7 (p<0.001) Conclusions In the analyzed groups fibromyalgia showed itself to be an aggravating factor adding to the rheumatoid arthritis. Furthermore patients diagnosed with both RA and FM needed a more aggressive change in their treatment regimen showing that an extremely careful approach is needed in the RA cases where a concomitant FM may develop simultaneously Disclosure of Interest None Declared
Background Spondyloarthritis (SpA) defines a group of interrelated diseases with heterogeneous clinical presentation. Regarding the shared distinguishing features one can mention uveitis as an important extraarticular involvement with a highly suggestive impact on the future evolution of SpA. Objectives To investigate the prevalence of uveitis in patients with recent onset of inflammatory lumbar pain (ILP) which can be suggestive for developing SpA and to assess the interrelation of uveitis with other specific features of SpA patients. Methods We enrolled 49 patients with a reported onset of ILP within a maximum of 3 months prior to the referral. All patients were assessed in the Rheumatology Department over a 3 year period, between 2009-2012. The subjects were included based on their personal evolution into different disease group, they had a mean age of 46.3±5 years aut of which 36 males and 13 females. Patients were monitored and reevaluated every 3 months during the first year and then every 6 months for the final 2. Positive diagnosis of SpA was based on the established criteria such as: the New York modified criteria for ankylosing spondylitis (AS). Uveitis was defined by an ophthalmologic episode diagnosed as such by an ophthalmologist. Data on the baseline functional status, imaging features, and serologic tests were compared in patients with and without uveitis. Factors associated with the presence of uveitis were identified both through univariate and multivariate statistical analysis (logistic regression) Results The prevalence of uveitis at inclusion was 10.2 %. Uveitis was observed after the first episodes of ILP in 40 % of patients. The presence of uveitis was significantly associated (univariate) with pain in the lumbar spine, infection preceding inflammatory disease, a previous positive diagnosis of inflammatory bowel disease (IBD); enthesitis or radiologic evident coxo-femural joint involvement, but we could not certify a relation with the fulfillment of specific classification criteria, HLA-B27, Bath Ankylosing Spondylitis Disease Activity Index or the Bath Ankylosing Spondylitis Functional Index. Stastical multivariate analysis showed a positive association between uveitis and pain in the lumbar spine, infection preceding inflammatory disease, a previous diagnosis of IBD (P < 0.05). Conclusions Our study showed association of ILP with the onset of IBD and infectious episodes which suggests an important role of environmental factors in the incidence of uveitis in SpA. These data stand the ground for a more thorough approach of the patient whom presents with an uveitis episode since they might already be eligible for the inclusion in a SpA category and evaluated accordingly. Disclosure of Interest None Declared
Background Ankylosing Spondylitis (AS) is one of the most common chronic autoimmune and autoinflammatory diseases and it can be defined both by its debilitating phenotype and its major social impact. Bone mineral density is known to be decreased in patients with AS compared to non-diseased controls therefore quantifying the absolute risk of developing a vertebral fracture becomes esential in identifying the patient subset in whom the correct therapeutical measures are highly needed. Objectives To study the incidence of vertebral fractures in osteoporotic patients with AS, and to educate health professionals who may be involved in the management of AS patients with possible spinal injuries, despite not being a rheumatologist Methods We enroled 35 patients - all men- whom were admitted in our Clinical Department over a 2 year – period, between 2010 and 2012 and they all fulfilled the New York modified criteria for AS. In order to assess disease activity and severity we performed the following for the entire study group: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) and further more spinal mobility (Schober’s test, chest expansion and occiput-to-wall distance), radiological damage (syndesmophytes, sacroiliitis grade) and Bath Ankylosing Spondylitis Function Index (BASFI). Bone mass density (BMD) of the lumbar spine was measured by dual energy X-ray absorptiometry (DXA) and all patients had a baseline thoracolumbar radiograph. A prevalent vertebral fracture was defined according to the Genant classification criteria. Results Osteoporosis was identified in 20% patients and 28.57% of the patients had osteopenia. Vertebral fractures were identified in 14.28 % of the patients, and among them, 2 had at least 2 separate incidents- the majority of them were grade 2 (95% confindence intervals). In 57,14% from the patients with osteoporosis we identified VF, but we found no reported VF in the ones with osteopenia. Logistic regression analysis showed that disease duration (OR per year 1.02, 95% CI 1.03-1.06, p = 0.011), Bath Ankylosing Spondylitis Functional Index score (OR per score 1.17, 95% CI 1.03-1.30, p = 0.015) and wall-occiput distance (OR per cm 1.15, 95% CI 1.08-1.23, p < 0.001) were all associated with prevalent fracture but there were no significant correlations of BMD with disease activity or severity variables (ESR, CRP and BASDAI all p< 0.01). Conclusions AS is an independent factor for the development of osteoporosis induced vertebral fractures and the risk increases with the disease duration and the impairment of functional status. We also find it highly important that medical staff have an understanding of the extreme caution that is needed in the management of possible spinal injuries in patients with ankylosing spondylitis. Disclosure of Interest None Declared
Background Hyperuricemia has been associated with the development of hypertension, metabolic syndrome, diabetes mellitus and represents a well recognized risk factor for cardiovascular disease. Objectives To determine ultrasonographic (US) changes suggestive of gouty arthritis in the joints and the hyaline cartilage from hypertensive patients with hyperuricemia asymptomatic for gouty arthritis. Methods We performed a cross-sectional, controlled study including US examinations of the first metatarsal-phalangeal joints (first MTPJs) and knees of hypertensive patients hospitalized for monitoring. 72 hypertensive patients with hyperuricemia asymptomatic for gouty arthritis and 68 normouricemic hypertensive patients were included. Ultrasound morphostructural changes followed were: the double contour sign determined by the hyperechoic enhancement of the condrosynovial margin of the hyaline cartilage and the intraarticular tophi, using a MyLab25 Gold scanner (Esaote, Italy), with a multifrequency linear array transducer (10-18MHz). Results The double contour sign was found in 43% of the first MTPJs from hyperuricemic hypertensive patients, in contrast to only 6% control group of normouricemic hypertensive patients (p < 0.0001), as well as on the femoral cartilage (25% versus 3%; p < 0.001). Intra-articular tophaceus material was detected in 16 hyperuricemic patients but in none of the normouricemic ones (p < 0.001). Conclusions These findings demonstrate that ultrasound detected morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in hypertensive patients clinically asymptomatic for gouty arthritis, increasing the risk of subsequent development of the articular disease, with activation of inflammation and thus creating a vicious cycle of increasing the risk for cardiovascular disease. Monitoring morphostructural changes suggestive of gouty arthritis in this hypertensive population and lowering serum uric acid levels might be beneficial in reducing the risk of further complications from both cardiovascular and arthritis point of view. References C. Pineda et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Research & Therapy 2011, 13:R4 doi:10.1186/ar3223 Disclosure of Interest None Declared
Background Patients with rheumatoid arthritis (RA) who have achieved clinical remission (CR) or low disease activity (LDA) may have synovitis detectable by ultrasound (US) and continue to get joint distruction. Despite an essential role for RA patients stability and mobility, the ankle joints are frequently omitted in activity scoring systems including DAS 28. Consequently patients with DAS 28 CR or LDA frequently maintain a symptomatic ankle and only few studies have assessed pathologies detected by ultrasonography in these circumstances. Objectives The main purpose of the study was to evaluate the ankle joint involvement through power Doppler ultrasound in patients with RA who have achieved CR or LDA according to DAS 28 EULAR criteria. Methods 50 consecutive RA patients (ACR/EULAR classification criteria 2010) who have achieved CR or LDA were reviewed. Patients underwent DAS28 assessment and US of the ankle joints. Synovitis was detected by power Doppler (PDUS) and scored on a 0–3 semi-quantitative scale. A total number of 100 ankle joints were examined using MSUS. Talonavicular, intertarsal- and tarso-metatarsal joints as well as flexor and extensor tendons were investigated. Results Ankle pain was recorded in 31 patients while 19 patients were asymptomatic. Pathology detected was arthritis of the tibiotalar and/or talonavicular joint in 72% of the patients (36 out of 50), followed by tenosynovitis of the flexor tendons in 56% of the patients (28 out of 50). Gray scale findings were observed in 90.3% of the symptomatic patients (28/31) as well as in 53% of the asymptomatic patients (10/19) (p<0.01). PDUS activity was higher in symptomatic patients - 35% (11/31) compared to 21% in asymptomatic patients (4/19) (p<0.01). 10 patients (43%) in CR presented gray scale arthritis and tenosynovitis and 13% PD activity while 26 patients (93%) in LDA were positive for gray scale arthritis and tenosynovitis and 43% patients for PD signal. Conclusions Ultrasonographic Doppler imaging reflects disease activity even in patients with low activity or in remission.Ankle joint is frequently involved according to ultrasound evaluation in patients with RA in DAS 28 LDA or CR. Most frequent pathologies detected by MSUS were arthritis of the tibiotalar and talonavicular joint, followed by tenosynovitis of the flexor tendons. Pathologic findings are also very common in asymptomatic patients with RA, whereas PDUS activity is predominately observed in symptomatic patients. Ankle joint should be more closely monitored for pathological findings in patients with LDA or CR as it frequently represents a source of pain, instability and disability in patients with RA. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5946
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