Objectives To analyse clinical and sonographic differences between patients with rheumatoid arthritis and psoriatic arthritis with clinical remission or low disease activity on anti-TNF therapy. Methods Subanalysis of the 12 months follow-up prospective study INMUNOREMAR. Patients diagnosed with rheumatoid arthritis or polyarticular psoriatic arthritis in clinical remission or low disease activity by DAS28 on anti-TNF therapy (etanercept, adalimumab or infliximab) were included. Clinical, epidemiological, demographic and serological data at baseline were analysed. Ultrasound scans of both knees and hands (wrists, metacarpophalangeal [MCP], proximal interphalangeal [PIP] flexor and extensor tendons of the hand) were made. We quantified synovial hypertrophy (grades 0-3) and power Doppler signal (grades 0-3) in all patients and a global synovitis score was calculated. Data at study entry are presented. Results 100 patients (46 RA and 54 PsA, mean age (SD) 58.2 (11.4) years, disease duration 15.9 (8.8) years) were included. 50 patients were on etanercept, 35 adalimumab and 15 infliximab. 51 patients (39 PsA) were on monotherapy and 46 (31 PsA) were on anti-TNF dose-reduction. 48 patients had power Doppler signal and 45 met criteria for ultrasound-active synovitis (synovial hypertrophy + Power Doppler signal). Patients with psoriatic arthritis had significantly-less disease activity (p=0.0001 for DAS28-VSG) and fewer sonographic findings (Table 1): only 14 patients with PsA met criteria for active synovitis (31 for RA, p=0.0001). Table 1. Study population: clinical and ultrasound characteristics RA (46) PsA(54) P Female (%) 37(80.4) 25(46.2) 0.0001 Age (SD) (years) 62.6(10.9) 54.5(10.5) 0.0001 Disease duration (SD) (years) 17.0 (9.7) 14.9(8.0) 0.240 DAS28-VSG (SD) 2.31(0.5) 1.88(0.5) 0.0001 Remission (%) 30 (65.2) 47 (87.0) 0.016 Treatment Etanercept (%) 24(52.1) 26(48.1) Adalimumab (%) 16(34.7) 19(35.1) Infliximab (%) 6(13) 9(16.6) Dose reduction (%) 15(32.6) 31(57.4) 0.016 Prednisone (%) 14(30.4) 1(1.8) 0.0001 SH+PD (%) 31(67.3) 14(25.9) 0.0001 SH2+PD (%) 18(39.1) 1(1.8) 0.0001 Ultrasound global score (SD) 9.5 (6.8) 6.8(5.6) 0.046 RA, Rheumatoid arthritis; PsA, Psoriatic arthritis; SH, Synovial hypertrophy; PD, Power Doppler; ACPA, Anticitrulline-protein antibody; SD, standard deviation. Conclusions Among patients with clinical remission or low disease activity and anti-TNF therapy, PsA patients had significantly less clinical and sonographic activity. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5519
BackgroundVitamin D is a steroid hormone with pleiotropic effects on physiological processes. Among others, immune system regulation and their analogues prevent symptom development of autoimmune diseases such as SLE. A previous research in a colombian clinic found a prevalence of hipovitaminosis D of 87% in healthy population, but hypovitaminosis D is higher in SLE patients than healthy controls.ObjectivesTo establish the prevalence of hypovitaminosis D in patients with SLE and relationship with SLEDAI – 2K.MethodsA cross sectional study was carried out. 80 medical records with a diagnoses of SLE o CIE-10 M30-M36 were identified and we included patients>18 years of age who meet at least 4 of the 11 criteria to diagnoses of SLE for medical record. The analysis included means, DS and Kruskall Wallis with p-value<0.05.ResultsThe majority of patients are women (94%), with an average age of 39.9 years, married (41%), with secondary education (56.7%) and different occupations. It was found that the patients with higher activity, had lower vitamin D levels. Additionally, if the patient had lupus nephritis, vitamin D levels decreased even more.Abstract AB0618 – Figure 1ConclusionsPatients with active systemic lupus Erythematosus, (SLE) have hypovitaminosis D more frequently and we noticed that patients with renal involvement have the lowest levels of vitamin D, which justifies a later analysis.References[1] American College of Rheumatology. Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis Rheum. 1999Sep;42(9):1785–96.[2] Simioni J, Heimovski F, Skare T. On lupus, vitamin D and leukopenia. 2016;56(3):206–211.[3] Guzman R.A, Piñeros L.G, Theran A, Flechas J, Mejía M. AB0795 Hypovitaminosis D and Calcium Intake of Adult Population in Bogota (DICAVITD). Ann Rheum Dis2016;75:1175–1176.[4] Alele J., et al. Autoimmun Rev2010;9:137–39.[5] Dall, era M., et al. in Kelley&Firestein,s Textbook of Rheumatology. 10th Ed, Elsevier; Philadelphia 2017; 1368–89.Disclosure of InterestNone declared
Objectives To study the relationship between serum trough levels of TNF antagonists -etanercept (ETN), adalimumab (ADA), infliximab (IFX)- and subclinical active-synovitis (SAS) by ultrasound (US) in patients diagnosed with RA and PsA in clinical remission (CR) or low disease activity (LDA). Methods Prospective, multicenter study of patients diagnosed with RA or PsA attended by three hospital outpatient clinics in Catalonia, Spain treated with ADA, ETN or IFX for ≥3 months in CR or with LDA measured by DAS28-ESR in ≥2 consecutive visits. We determined serum trough levels (commercial ELISA Kit Promonitor®, Progenika SA) at 0, 4, 8 and 12 months of follow-up. Optimal cut-off trough levels for ADA were (>1.274 μg/ml), ETN (>1.242 μg/ml) and IFX (>1.5 μg/ml). Sonography of fingers and wrist joint of each hand was performed. Synovial hypertrophy (SH) and power Doppler signal (PD) for synovitis was evaluated at 0 and 12 months. SH plus PD signal was considered as SAS and a total synovitis score was calculated. We present the results at study entry (visit 0). Results Of 165 patients included, 100 (46 RA, 54 PsA) underwent US examination: 62% female, mean age 57±13 years, mean DAS28-ESR 2±0.5, 77% CR and 23% with LDA, 51% on monotherapy (26% RA, 72.2% PSA), 46% receiving low dosage of biologic (32.6% RA, 57.4% PsA), and taking ADA (35), ETN (50) and IFX (15). SAS was found in 45 patients (31 RA and 14 PsA), representing 42,8% of patients treated with ADA, 46% ETN, and 46,6% IFX. Total subclinical synovitis score was 8±6.3. No significant differences were observed in mean SDAI, ESR, CRP, DAS28-ESR, drug serum trough levels or percentage of suboptimal trough anti-TNF serum levels between patients with or without US SAS. After using a logistic regression model, only diagnosis of RA, but not drug serum levels was significantly associated with the presence SAS. No significant correlation between total synovitis score and drug levels were found. US active-synovitis negative (PD+GS) US active-synovitis positive (PD+GS) p (n=55) (n=45) ADA serum trough levels (mean ± SD) (n=35) 6.9±4 7.2±4 0.836 ADA suboptimal serum trough levels (<1.274 μg/ml) (n=5) 3 2 0.619 ADA optimal serum trough levels (>1.274 μg/ml) (n=30) 17 13 0.419 ETN serum trough levels (mean ± SD) (n=50) 1.8±1 1.8±1 0.994 ETN suboptimal serum trough levels (<1.242 μg/ml) (n=18) 10 8 1.00 ETN optimal serum trough levels (>1.242 μg/ml) (n=32) 17 15 0.552 IFX serum trough levels (mean ± SD) (n=15) 4.1±4 3±2 0.570 IFX suboptimal serum trough levels (<1.5 μg/ml) (n=5) 3 2 1.00 IFX optimal serum trough levels (>1.5 μg/ml) (n=10) 5 5 0.573 Conclusions Subclinical synovitis by US is frequent in patients with RA or PsA receiving TNF who achieve good disease control. Drug serum levels of TNF antagonists do not correlate with subclinical synovitis in these patients. References Chen D-Y, et al. Ann Rheum Dis 2014;0:1-9 Disclosure of Interest J. Inciarte-Mundo Grant/research support: Grant from Hospital Clinic of Barcelona (Premi ...
Background Palindromic rheumatism (PR) is an intermittent arthritis that may evolve to rheumatoid arthritis (RA), especially in patients with anti-citrullinated protein antibodies (ACPA), although significant numbers of patients do not evolve to RA after several years of follow-up. It is not known whether patients may have subclinical synovitis during the intercritical phase of the disease and whether this is a risk factor for progression to RA. Objectives To analyze the presence of subclinical synovitis (measured by power Doppler ultrasound) in patients with pure PR in the asymptomatic phase and compare ultrasound (US) findings in ACPA (+) and ACPA (-) patients. Methods Patients diagnosed with pure PR that had not progressed to chronic rheumatic disease at the time of the study were included. Clinical, demographic, serological and therapeutic variables were collected. US assessment of both hands, including the wrists, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, and the flexor and extensor tendons of the wrists and hands was performed in all patients during the asymptomatic disease phase. An Esaote USscanner with a MyLab25 12 MHz linear probe was used for all USassays, which were performed by the same rheumatologist, with experience in musculoskeletal US. The US assessment searched for and quantified (grades 0-1-2-3) subclinical synovitis (coexistence of synovial hypertrophy and power Doppler signal) in the areas mentioned above. Results 40 patients (70% women), mean age 51.1±11.9 years, mean disease duration 2.4±11.3 years, were included. The most-commonly involved joints during the attacks were: MCP (47.5%), wrist (27.5%), PIP (17.5%). In 47% of patients, the duration of the attackswas< 48hours. Rheumatoid factor (RF) and ACPA (CCP2 commercial test) were positive in 52.5% and 72.5% of patients, respectively. Seventy per cent of patients were treated with DMARDs, most frequently hydroxychloroquine. US showed a power Doppler signal in 13 patients (32.5%), most-frequently in the carpal joints (30%), and second MCP (25%), and 87.5% of patients had some degree of synovial hypertrophy, of which the highest degree was in the carpal joints (35%) and MCP (34.3%). No significant differences in US results were found between ACPA-positive or ACPA-negative patients (Table 1). US performed in 4 patients during RP attacks showed 3 had active synovitis (synovial hypertrophy and power Doppler signal). Conclusions US showed most patients with pure PR have some degree of synovial hypertrophy in the joints of the hand in the asymptomatic phase, but only one third had subclinical synovitis (synovial hypertrophy and power doppler signal), with no differences between ACPA-positive and ACPA-negative patients. Disclosure of Interest None Declared
Objectives To identify and characterize subclinical synovitis in patients with rheumatoid arthritis (RA) in clinical remission using Power Doppler Ultrasound and immunohistology Methods Prospective study with a 12- month follow-up. We will select patients with RA who are in clinical remission (defined as DAS28 <2.6) as evaluated by two rheumatologists. Clinical, epidemiological, demographic and serological data will be analyzed. Patients will undergo ultrasonography of both knees and hands (wrists, metacarpophalangeal [MCP], proximal interphalangeal [PIP], flexor and extensor tendons of the hand). Sonography findings were quantified as follows: synovial hypertrophy (grades 0-3) and power Doppler signal (grades 0-3). A portable ultrasound scanner (Esaote MyLab25) with a linear probe of 12 MHz was employed. Patients with active synovitis (synovial hypertrophy plus power doppler signal) will undergo synovial biopsy by arthroscopy or ultrasound-guided, depending on the size of the target joint. The correlation of Power Doppler signal, vascular patterns, the cellular infiltrate and cytokine expression in synovial tissue with the development of bone erosions assessed by MRI at 12 months will be performed, in order to identify prognostic markers. The ultimate goal is to recruit a total of 100 patients and 60 synovial biopsies. We here present the ultrasound results in the patients recruited so far. Results 42 patients have been recruited so far (35 women and 7 men with a mean age of 54 + -12.2 years and a mean disease duration of 117.3 + -88.3 months). Sixty-seven per cent and 76.2% of patients were positive for RF and ACPA, respectively. All patients were treated with DMARD and 42.9% were also in biological treatment. 88.1% of patients had synovial hypertrophy and 66.7% had Power Doppler signal. The most affected joint (with power Doppler signal) was the wrist (33.3%), followed by the 2nd MCP (9.6%). Patients with active synovitis had DAS28 (mean 2.26 versus 1.93, P = 0.016) and weight (mean 68.5 kg versus 59.3 kg, P = 0.018) significantly higher than patients without Power Doppler signal. No significant differences between patients treated with DMARDs and biologic therapy were found. Conclusions These preliminary results show that two-thirds of patients with RA in clinical remission exhibit power Doppler signal. The DAS28 was significantly higher in patients with active synovitis. No differences were found regarding baseline treatment. Disclosure of Interest None Declared
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