Recommendations for the management of AS were developed using an evidence-based approach followed by expert/physician consensus with high level of agreement. Involvement of a larger and more representative group of rheumatologists may improve their dissemination and implementation in daily clinical practice.

The authors investigated the significance of vomiting for hyperamylasemia and sialadenosis in patients with bulimia nervosa. Hyperamylasemia was found in 61% of the bulimics and in 20% of the restrictor anorectics but in no patients with binge‐eating syndrome. In more than three fourths of the bulimics there was a close positive correlation between the frequency of vomiting and total serum amylase levels. Both frequency and type of vomiting seem to be relevant to the extent of salivary gland enlargement. The significance of vomiting for the etiopathology of hyperamylasemia and for the diagnosis of eating disorders will be discussed. © 1993 by John Wiley & Sons, Inc.

Toxoplasmosis is a well-recognized opportunistic disease in HIV-infected individuals that is caused by the reactivation of a previous infection, primarily in the central nervous system, during profound immunodeficiency. Toxoplasmosis has been described more rarely in patients with cancer and chemotherapy. We report a case of a patient with a history of chemotherapy for non-Hodgkin lymphoma who developed pain and progressive paresthesia of the right arm 6 weeks after remission. Relapsing lymphoma was suspected, and steroid and radiation treatment were initiated, but the patient died 5 days later due to multiple organ failure. Autopsy revealed disseminated toxoplasmosis. This case illustrates that toxoplasmosis should be suspected in patients with neoplastic disease, especially lymphomas, who present with unexplained neurologic, pulmonary, or febrile symptoms during or after chemotherapy.

CDTect-RIA and CDTect-EIA for determination of serum carbohydrate-deficient transferrin (CDT) by radioimmunoassay and enzyme immunoassay respectively were tested for equality and precision in four European laboratories. For correlational studies, serum samples with CDT concentrations up to 130 U/l were analysed in accordance with a uniform trial schedule. The regression of CDT values obtained by the two procedures was computed for each laboratory using the method of Passing and Bablok. Slopes and intercepts of the regression functions did not differ significantly from the values 1 or 0, as proved by the corresponding 95% confidence intervals. Precision studies were computed using analysis of variance. For CDT concentrations at the upper reference limit for men, the within-day coefficients of variation (CVs) ranged between 0.7 and 6.4% (median 5.2%) for CDTect-RIA and from 4.3 to 9.2% (median 6.2%) for CDTect-EIA. The corresponding pure between-day CVs were 5.0-18.5% (median 9.8%) and 3.5-14.5% (median 10.9%). The study demonstrates the equality of CDT values obtained by CDTect-RIA and CDTect-EIA. According to this study, the two methods can be used interchangeably without getting fluctuating CDT values, e.g. in longitudinal studies.

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BackgroundRheumatoid arthritis (RA) is a common autoimmune disease, characterized by cartilage and bone destruction, autoantibody production and systemic disorders. (1) One of the most common comorbidities is anemia, caused by chronic inflammation or iron deficiency, with an high impact on quality of life. (2)ObjectivesAccording to older literature, the prevalence of anemia in RA patients is between 30 and 66%. (3) In a study cohort witch was designed to evaluate iron metabolism in chronic inflammation, we found lower prevalence. Therefor we investigated the actual prevalence of anemia in RA outpatients at our tertiary center at routine follow up in 2014 and at initial diagnosis. We also looked for the impact of disease activity and therapy strategies on the prevalence of anemia and hemoglobin levels.MethodsWe retrospectively analysed RA outpatients. As far as available, laboratory parameters, disease activity (CDAI, DAS28) and drug therapy were collected at the time of initial diagnosis and at a routine follow-up. Until now we included 305 patients. Anemia was defined as hemoglobin <120 mg/dl in women, and <130 mg/dl in men. Wilcoxon or Mann-Whitney-U-test was performed to compare subgroups, Spearman-Rank-Analysis was applied to analyse correlations.Results305 RA patients, with a mean disease duration of 11,3 years, were analyzed. Data of patients at initial diagnosis were only available after 2000. Prevalence of anemia at initial diagnosis was 15,9% and declined at follow up in 2014 to 11,45%. Anemia was significantly linked to more advanced inflammation as evidences by a significant correlation between ESR, CRP and hemoglobin levels at these time points and associated with a reduced MCV and MCH. Overall, patients showed a significant increase of hemoglobin levels upon treatment. Among patients receiving biological treatment in 2014 (n=122) 13,9% were anemic, with no difference between the biological agents. DMARDs (disease modifying anti-rheumatic drugs) were not inferior to biological treatment regarding the prevalence of anemia and hemoglobin levels.ConclusionsThe prevalence of anemia in RA patients appears nowadays to be significantly lower as previously described (3). This may be due to an earlier diagnosis of RA along with an overall better disease control with modern therapy strategies. Hemoglobin levels significantly increase under therapy in all patients, anemic or not. DMARDs are, in regard to the prevalence of anemia and hemoglobin levels not inferior to biologicals. Even under good disease control as seen in our patients, the prevalence of anemia in RA patients is about twice as high as in the general population (4). This is an interims report of a registry to systemically study and characterize anaemia in Austria along with the evaluation of the impact of anemia on the course of RA.ReferencesSchett G, Innes IB. The pathogenesis of rheumatoid arthritis. N Engl J Med. 2011 Dec 8;365(23):2205-19Weiss G, Schett G. Anaemia in inflammatory rheumatic diseases.Nat Rev Rheumatol. 2013 Apr;9(4):205-15Wilson A...

BackgroundRemission or at last low disease activity is the aim of drug therapy in patients with chronic inflammatory rheumatic diseases. We evaluated disease activity in patients treated with biologics and using data of the Austrian biologic registry.ObjectivesThe aim of this evaluation was to elucidate disease activity in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) at baseline and at control-visits every six months after inclusion in BioReg.MethodsData were extracted from the Austrian BioReg registry (bioreg.at) which was initiated in 2009 to document patients treated with one of the biologics approved in Austria. Patients with ongoing biologic therapy as well as biologic-naïve patients starting biologic therapy can be included (baseline, BL). Further documentation is recommended about every six months (V1,V2 up to V11). Meanwhile, 1877 patients (rheumatoid arthritis (RA) n=1046, ankylosing spondylitis (SpA) n=446, psoriatic arthritis (PsA) n=322, other disease n=63) have been documented. Estimation of disease activity is done using DAS-28 as well as RADAI-5 in RA, SASPA in PsA, and BASDAI in SpA.ResultsDAS-28 (median values of BL; V1; V2; V9; V10) of patients with RA are 3,30; 2,51; 2,58; 2,52; 2,49, the respective RADAI-5 values are 3,2; 2,4; 2,2; 2.0; 2,3. BASDAI in patients with SpA were 3,60; 2,61; 2,45; 2,63; 2,20. Median values of inflammation's laboratory markers (ESR in mm/1st hour and CRP in mg/l) were always within the normal range (ESR and CRP in RA 15; 12; 12; 12,5; 14 and 2,0; 2,0; 2,0; 2,0; 2,0; in SpA: 8; 6; 7; 8; 8; and 2,0; 1,4; 1,4; 1,1; 1,0 in PsA 9; 8; 9; 7 (V7); 6 (V8); and 1,6; 1,5; 1,4; 1,9 (V7); 0,8 (V8)).ConclusionsOur data confirm the efficiency of therapy with biologicals. During 5 years of continuous treatment more than half of patients with RA reach and keep remission with a DAS-28 below 2,6 and normal values of ESR and CRP. Also patients with SpA and PsA show similar successful therapeutic response.AcknowledgementsBIOREG is supported by an unlimited industrial grantDisclosure of InterestNone declared

Background:Gender differences in prevalence and disease course are known in various rheumatic diseases; however, investigations of gender difference concerning therapeutical response have yielded variable results.Objectives:The aim of this retrospective study was to investigate, whether a gender difference in response rate to biological disease-modifying antirheumatic drugs (bDMARDs) and apremilast in bDMARD-naïve patients could be observed across the three most prevalent inflammatory arthritis diseases: rheumatoid arthritis (RA), spondylarthritis (SpA) and psoriatic arthritis (PsA). Additionally, a response to individual TNF blockers was investigated in this respect.Methods:Data from bDMARD-naïve RA-, SpA- and PsA-patients from Bioreg, the Austrian registry for biological DMARDs in rheumatic diseases, were used. Patients with a baseline (Visit 1=V1) and follow-up visits at 6 months (Visit 2=V2) and 12 months (Visit 3=V3) were included and response to therapy with TNF-inhibitors (TNFi), furthermore to therapy with rituximab, tocilizumab and apremilast was analyzed according to gender. The remaining bDMARDs were not analyzed due to small numbers. Key response-parameter for RA was disease activity score (DAS28), whereas for PsoA the Stockerau Activity Score for Psoriatic Arthritis (SASPA) and for SpA the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were employed; in addition, the Health assessment Questionnaire (HAQ) was used. Data were analyzed in R Statistic stratified by gender using Kruskal-Wallis and Wilcoxon tests.Results:354 women and 123 men with RA (n=477), 81 women and 69 men with PsA (n=150), 121 women and 191 men with SpA (n=312) were included. No significant differences in biometrics was seen between female and male patients at baseline in all diseases.In RA patients overall DAS28 decreased from baseline (V1) to V2 and V3 (DAS28: V1: male: 4.38 [3.66, 5.11], female: 4.30 [3.68, 5.03], p(m/f) = 0.905; V2: male: 2.66 [1.73, 3.63], female: 3.10 [2.17, 3.98], p(m/f) = 0.015; V3: male: 2.25 [1.39, 3.36], female: 3.01 [1.87, 3.87], p(m/f) = 0.002). For TNF inhibitors (n=311), there was a significant difference between genders at V2 (Fig.1a). Patients receiving Rituximab (n=41) displayed a significantly higher DAS28 at baseline in females, which diminished in the follow up: V1: (p(m/f) p=0.002; V2: p=0.019; V3: p=0.13); response to tocilizumab (n=63) did not show any gender differences.In PsA patients overall SASPA decreased from baseline (V1) to V2 and V3 (SASPA: V1: male: 4.00 [2.80, 5.20], female: 4.40 [2.80, 5.80], p(m/f) = 0.399; V2: male: 2.20 [1.20, 3.50], female: 3.40 [2.00, 5.00], p(m/f) = 0.071; V3: male: 1.80 [0.80, 2.70], female: 3.01 [2.35, 4.80], p(m/f) = 0.001). For TNF inhibitors (n=79), there was a significant difference between genders at V3 (Fig 1a). For Apremilast (n=39), there was a significant difference between genders at V2 (Fig.1c).In SpA patients overall BASDAI decreased from baseline (V1) to V2 and V3 (BASDAI: V1: male: 4.70 [2.88, 6.18], female: 4.80 [3.30, 6.20], p(m/f) = 0.463; V2: male: 3.05 [2.00, 4.60], female: 3.64 [2.62, 5.41], p(m/f) = 0.039; V3: male: 3.02 [1.67, 4.20], female: 3.65 [2.18, 5.47], p(m/f) = 0.016). In V3 a differential BASDAI in response to TNFi (n=299) was observed (Fig.1a).Possible differences of response to individual TNFi (etanercept, infliximab, other TNFi) measured by HAQ were investigated in all diseases together. The difference between male and females was significant at baseline for all 3 TNFi; whereas with the use of ETA the significant difference was carried through to V2 and V3, it was lost with the use of IFX and was variable with the other TNFi (Fig.1b)Figure 1.Conclusion:Female patients showed a statistically lower response to TNFi in all three disease entities (RA, SpA and PsoA) to a variable degree in our homogenous central european population. Interestingly, the difference was not uniform across individual TNFi when measured by HAQ. Gender differences were also seen in response to Apremilast.Disclosure of Interests:Elisabeth Loibner: None declared, Valentin Ritschl: None declared, Burkhard Leeb Speakers bureau: AbbVie, Roche, MSD, Pfizer, Actiopharm, Boehringer-Ingelheim, Kwizda, Celgene, Sandoz, Grünenthal, Eli-Lilly, Grant/research support from: TRB, Roche, Consultancies: AbbVie, Amgen, Roche, MSD, Pfizer, Celgene, Grünenthal, Kwizda, Eli-Lilly, Novartis, Sandoz;, Peter Spellitz: None declared, Gabriela Eichbauer-Sturm: None declared, Jochen Zwerina: None declared, Manfred Herold: None declared, Miriam Stetter: None declared, Rudolf Puchner Speakers bureau: AbbVie, BMS, Janssen, Kwizda, MSD, Pfizer, Celgene, Grünenthal, Eli-Lilly, Consultant of: AbbVie, Amgen, Pfizer, Celgene, Grünenthal, Eli-Lilly, Franz Singer: None declared, Ruth Fritsch-Stork: None declared