Objective: To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA).
Methods:Multicenter study of SpA-related uveitis refractory to at least one immunosuppressive drug. The main outcome variables were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness.Results: Fifteen patients (13 men/2 women; 18 affected eyes; mean age 39±6 years) were evaluated. The underlying SpA subtypes were ankylosing spondylitis (n=8), psoriatic arthritis (n=6) and non-radiographic axial SpA (n=1). The ocular involvement patterns were recurrent anterior uveitis in 8 patients and chronic anterior uveitis in 7.Before GLM they have received methotrexate (n=13), sulfasalazine (n=6), pulses of methylprednisolone (n=4), azathioprine (n=3), leflunomide (n=2) and cyclosporine (n=1). Ten of them had also been treated with TNF-α blockers; etanercept (n=7), adalimumab (n=7), infliximab (n=6), and certolizumab (n=1). GLM was given at the standard dose (50 mg/sc/monthly) as monotherapy (n=7) p=0.03). Only minor side effects were observed after a mean follow-up of 23±7 months.
Conclusions:Our results indicate that GLM may be a useful therapeutic option in refractory SpA-related uveitis.
Background
Non infectious aortitis may present as an idiopathic isolated condition or associated with a wide spectrum of diseases. Aortitis often presents with nonspecific symptoms leading in many cases to an inappropriate diagnostic delay.
Objectives
Our aim was to analyze the clinical features and outcome of patients with aortitis in order to improve the diagnosis of this entity.
Methods
We studied 32 patients (22 women and 10 men) with a mean age of 68 years (range, 45-87 years) at the time of diagnosis. The median interval from the clinical onset to the diagnosis was 21 months. F18-FDG PET scan was the usual radiological method for diagnosing aortitis.
Results
The underlying conditions were: giant cell arteritis (n=13 cases); isolated polymyalgia rheumatica (PMR) (n=11); Sjögren syndrome (n=2), Takayasu arteritis (TakA) (n=1); sarcoidosis (n=1), ulcerative colitis (n=1), psoriatic arthritis (n=1), and idiopathic aortitis (n=2). The most common clinical manifestations at diagnosis were: PMR features, often atypical in the clinical presentation (n=23 patients, 72%); diffuse lower limb pain (n=16 patients, 50%); constitutional symptoms (n=12 patients, 37%), inflammatory back pain (n=9 patients, 28%) and fever (n=7 patients, 22%). In most of the cases, serum acute phase reactants were increased, with a median erythrocyte sedimentation rate of 46 mm/1st hour and a median serum C-reactive protein of 1.5 mg/dL.
Conclusions
In conclusion, aortitis is not an uncommon disease. The diagnosis is often a challenge for the clinician. The presence of PMR features, in particular when they are atypical, unexplained low back or limb pain, constitutional symptoms along with increased acute phase reactants should be considered “red flags” to suspect the presence of an underlying aortitis.
Acknowledgements
This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest
None declared
DOI
10.1136/annrheumdis-2014-eular.2978
Background
In 1990 The American College of Rheumatology (ACR) established criteria for the classification of vasculitis. Cutaneous vasculitis (CV) comprises a wide and heterogeneous group of entities.
Objectives
Our aim was to revise the usefulness of ACR-1990 criteria in classifying patients with CV.
Methods
Retrospective study of a wide and unselected series of patients with CV from a single university hospital from January 1976 to January 2012. Patients were classified according to the 1990 ACR methodology and criteria.
Results
773 Patients (351 women/422 men) with a mean age of 34.1±27.4 years were diagnosed as having CV.
Applying the 1990 ACR criteria patients were classified as secondary to connective tissue diseases (n=35), major infections (n=27), malignancies (n=16), mixed essential cryoglobulinemia (n=13), Wegener Granulomatosis (n=3), Churg-Strauss syndrome (n=3) and Polyarteritis nodosa (n=3). The remaining 673 patients were classified as Hipersensitivity vasculitis (n=247; 36.6%) or Henoch Schönlein Purpura (n=414; 61.4%). Disappointingly, 127 (18.8%) met criteria for both entities and 12 out of 673 cases did not meet criteria for HV nor HSP and were not classified.
Conclusions
The ACR-1990 criteria for vasculitis do not properly classify patients with CV.
Acknowledgements
This study was supported by a grant from “Fondo de Investigaciones Sanitarias” PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from “Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest
None declared
DOI
10.1136/annrheumdis-2014-eular.3111
ObjectivesTo analyze the clinical characteristics, most frequent diagnostic methods and different treatments used in spondylodiscitis (SD) in our sanitary area.MethodsDescriptive and retrospective study of patients with the diagnose of infectious SD (clinical or microbiological) from 2000 to 2016. In each case we studied the presence of underlying diseases, an episode of infection in the previous 6 months, way of presentation, location, diagnostic methods, treatment and evolution, comparing among different etiologies.Results62 patients were diagnosed of spondylodiscitis. 41 men (24–90 years: mean 71,7). 58 were pyogenic, 3 tuberculous (TBC) SD, and 1 candida. The patients with TBC were younger (mean age: 45.3; p<0.05). An underlying disease was observed in 51 patients, specially Diabetes Mellitus (DM) (31% of SD). 4 patients were Rheumatoid Arthritis patients. A previous episode of bacteriemia or a primary source of infection was identify in a 33% of the cases, obtaining a microbiological isolation in 47/62 (75.8%) SD (43 bacterial, 3 TBC and 1 Candida). The most frequent pathogens were Gram +(G+) (50% of the total SD) being S. aureus and S epidermidis responsible of 21/62 cases (33.8%). In the 94% of SD caused by G+, hemocultures positive were obtained, in comparison to a 55% of SD caused by G- (p=0.016).The most frequent presentation symptoms were: lumbar pain (95.1%), fever (50%) and neurological deficit (18%). Leucocytosis was present in only a third of the SD, observing an increase of ESR and CRP in the pyogen etiology (p no significative for low number of patients in SD group caused by TBC) and lower levels of hemoglobin, cholesterol and albumin. Lumbar area was affected in the 77% of SD (77% in G+ and 50% in G-). In a 13% of patients, more than one intersomatic space was affected, being visible the presence of an abscess in 44/62 cases (71%). It was necessary surgical treatment in 7/44 (16%). 5 patients died due to pathology related to SD (8%), without any correlation with a risk factor and other 5 presented a relapse in the subsequent months.Conclusions
the bacterial SD are the predominant group, being DM the most frequent risk factor.The incidence of SD due to TBC and fungi is scarce in our environment, being absent the Brucella etiology.The G+ SD usually have a previous associated bacteriemia.The majority of the patients had pain in the presentation, but only half of them had associated fever.The most frequent location of SD was lumbar.We established a 8% of mortality rate in our sanitary area.
Disclosure of InterestNone declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.