A significant proportion of PsA patients had asymptomatic hyperuricemia. It was closely related with BMI, which represented metabolic dysregulation; but not with severity of skin disease, joint involvement or renal function.

ObjectivesTo report the 10-year outcome of lupus nephritis (LN) treated with mycophenolate mofetil (MMF) or tacrolimus (TAC) induction in a randomised controlled trial.MethodsPatients with active LN were treated with MMF or TAC combined with high-dose prednisolone. Responders were switched to azathioprine (AZA) at month 6. Clinical outcomes at 10 years (renal flares, renal function decline and mortality) were assessed. Factors affecting prognosis were studied by Cox regression. Urine protein-to-creatinine ratio (uPCr) and estimated glomerular filtration rate (eGFR) at different time points were evaluated for their prediction of a poor prognosis by receiver operating characteristic (ROC) analysis.Results150 patients were studied (age 35.5±12.8 years). Complete renal response rate was similar between MMF (59%) and TAC-treated patients (62%; p=0.71). AZA maintenance was given to 79% patients. After 118.2±42 months, proteinuric and nephritic renal flares occurred in 34% and 37% of the MMF, and 53% and 30% of the TAC groups of patients, respectively (p=0.49). The cumulative incidence of a composite outcome of ↓eGFR ≥30%, chronic kidney disease stage 4/5 or death at 10 years was 33% in both groups (p=0.90). Factors independently associated with a poor renal prognosis were first-time LN (HR 0.12 (0.031 to 0.39); p=0.01), eGFR (HR 0.98 (0.96 to 0.99); p=0.008) and no response at month 6 (HR 5.18 (1.40 to 19.1); p=0.01). ROC analysis revealed an uPCr >0.75 and eGFR of <80 mL/min at month 18 best predicted a poor renal prognosis.ConclusionsLong-term data confirmed non-inferiority of TAC to MMF as induction therapy of LN. An uPCr≤0.75 and eGFR of ≥80 mL/min at month 18 best predicted a favourable 10-year outcome and may be suitable targets for induction/consolidation therapy.Trial registration numberNCT00371319.

Aim Fatigue is commonly associated with psoriatic arthritis (PsA). However, information about its prevalence and associated factors is sparse. The primary objective here was to find the prevalence and magnitude of PsA fatigue. The secondary objective was to explore its associated risk factors, particularly emphasis on the effect of disease activity control. Methods PsA patients who fulfilled Classification Criteria For Psoriatic Arthritis were consecutively recruited from local rheumatology clinics. Fatigue was assessed by a 13‐item self‐administered questionnaire (Functional Assessment of Chronic Illness Therapy – Fatigue [FACIT‐F]) (0‐52). Data collected and analyzed included: demographic data, disease activity data, comorbidities and medications use. Results There were 231 eligible PsA patients recruited. The mean FACIT‐F score was 37.5 ± 9.1. Severe fatigue, defined as FACIT‐F score < 30, was found in 49 (22.1%) of them. The univariate model identified these associated factors of fatigue: tender and swollen joint count, dactylitis count, Psoriasis Area and Severity Index (PASI) score, pain and general health perception, Disease Activity in Psoriatic Arthritis (DAPSA) score, Health Assessment Questionnaire, the use of cyclosporine, sulphasalazine and biologic agents. The final regression model identified DAPSA and PASI were closely associated with severe fatigue (P = .003 and P = .04 respectively). No associations with fatigue were found between age, gender, disease duration, comorbidities and medication use. However, there were weak correlations between the magnitude of FACIT‐F score, DAPSA and PASI with r = −.3 and r = −.26 respectively. Conclusion Severe fatigue was common in PsA patients, and its magnitude was closely correlated with DAPSA and PASI score, indicating its multifactorial nature. Achieving DAPSA and PASI remission could significantly alleviate the fatigue intensity to a certain extent. However, treatment for PsA‐related fatigue should adopt a multidisciplinary approach in addition to disease activity control.

Aim The primary objective of this study was to describe the clinical characteristics of psoriatic arthritis (PsA). The secondary objective was to evaluate the prevalence of various PsA comorbidities and their associated factors, with particular emphasis on metabolic syndrome (MetS). Methods Consecutive patients fulfilling the Classification Criteria for Psoriatic Arthritis (CASPAR) from two local hospitals were recruited between June 2016 and January 2018. Demographic data and related clinical parameters were collected and analyzed. MetS was defined by the International Diabetes Federation criteria for Asians. Results For the study, 201 eligible PsA patients were recruited: 124 were men and 77 were women. The mean age of onset of PsO and PsA was 36.6 ± 14.2 and 44.5 ± 12.6 respectively. Of the patients, 64.2% had central obesity, 18.4% had diabetes, 32.8% had hypertension and 35.8% had MetS. Univariate analysis showed that the (1) age onset of PsA, (2) PsA duration, (3) PsO duration, and (4) tender joint-count were the potential associative factors of MetS. Subsequent regression model identified that both age onset and disease duration of PsA were significantly associated with MetS, with p-values of 0.02 and 0.018, respectively. Older age of onset (46.5 ± 12.2 vs 43.4 ± 12.7 years) or longer disease duration (9.8 ± 8.4 vs 7.0 ± 6.7 years) of PsA increased the likelihood of developing MetS. No association of MetS was found with ESR or CRP levels, PASI, dactylitis count, enthesitis index, tender and swollen joint count, age onset of PsO and severe skin status. Conclusion PsA is a heterogeneous disease with an extremely diverse range of clinical features. It is also notably associated with other comorbidities, especially metabolic syndrome, in which it is closely related to arthritis onset and duration. In view of their common prevalence, regular screening of these PsA-related comorbidities is highly recommended.

Background Urate lowering therapy (ULT) can effectively reduce serum urate level (SUA) and flares for gout, thereby minimizing progressive joint damage. Despite advances in therapies for gout and the publication of international guidelines, studies repeatedly showed that many patients remained undertreated worldwide. To help achieving treatment targets for gout, a rheumatology nurse follow-up programme (RNFP) was set up to provide patients with comprehensive education and telephone follow-up to monitor the disease control, treatment adherence and occurrence of adverse drug effects. Appropriate and timely intervention and counseling would be given to patients who were found to have adverse drug effects or treatment non-concordance. Objectives The objectives of this study were to evaluate the effectiveness of RNFP in achieving the desired SUA for patients taking ULT and its role in detecting adverse drug effects and treatment concordance problems. Methods This was a retrospective, observational study in a regional hospital in Hong Kong serving predominantly Southern Chinese. Patients with gouty arthritis with or without tophi requiring initiation or titration of ULT (allopurinol, probenecid or febuxostat) were recruited into the RNFP by rheumatologists. Patient profiles, SUA at the time of recruitment and end of study, incidents of adverse drug effects and drug non-concordance were recorded. The primary outcome was the achievement of target SUA of <0.3 mmol/L and <0.36 mmol/L for gouty arthritis patients with and without tophi respectively at study end. Results From May 2011 to December 2013, 89 patients were recruited into the programme. Fifty three were male. Mean age was 66 years (33-93 years). Eighteen patients had tophi. Duration of nurse follow-up for each patient was 18.7 weeks (1.4 – 120.1weeks). Number of patients using allopurinol, febuxostat and probenecid were 81, 13 and 11 respectively. The mean pre-recruitment SUA was 0.529 mmol/L (0.330 to 0.945 mmol/L, standard deviation 0.112 mmol/L). Only 4.5% of gouty arthritis patients and none of the tophaceous gout patients had SUA within the defined therapeutic targets at the time of recruitment. At study end, mean SUA was significantly reduced to 0.364 mmol/L (-0.165 mmol/L; 95% confidence interval -0.124 to -0.190; P<0.00001). The percentage of patients achieving pre-defined target SUA were 38.9% and 53.7% for patients with and without tophi respectively. During the study period, 25 episodes of adverse incidents were detected. Majority (68%) was related to skin rash and pruritus. Thirty-one patients (34.8%) were identified to have drug concordance problems including self-adjustment of dosage and self-stopping of drug treatment. Conclusions Adverse drug effects and drug non-concordance were common in gouty arthritis patients receiving urate lowering therapy. A dedicated rheumatology nurse follow-up programme allows timely detection and intervention of treatment related problems to enhance the achievement of recommended target urate levels. Disclos...