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Objectives Rheumatoid arthritis (RA) patients who fail to respond to methotrexate (MTX) can receive biologic disease-modifying antirheumatic drugs (bDMARDs). The Torque Teno Virus (TTV) is a potential novel candidate for monitoring of immunosuppression. We explore TTV in these patients and association with clinical response to bDMARDs. Methods The BioBio Study is a multicentre randomized open-label trial, including RA patients with insufficient response to MTX. Patients were randomized to either TNFi (infliximab, INF), anti-IL-6 (tocilizumab, TCZ), CTLA4-Ig (abatacept, ABA) or anti-CD20 (rituximab, RTX) in addition to MTX. PCR was used to quantify TTV in the peripheral blood. Results TTV was measured in 95 patients (INF, n = 23; TCZ, n = 22; ABA, n = 27; RTX; n = 23). TTV increased by a median of 4.5*104 copies/ml (c/ml; inter quartile range [IQR] 0–7.5*105) after 3 months. TTV levels at month 3 were associated with SDAI (p= 0.03) and CDAI response (p= 0.026) at month 6. A TTV cut-off level of 1.2*106 c/ml at month 3 had a positive likelihood ratio of 2.7 for prediction of SDAI85% response at month 6. Conclusion Our data suggest that TTV levels increase upon TNF, CD20 and co-stimulation blockade and associate with clinical response to bDMARDs in RA patients. Trial registration ClinicalTrials.gov; https://clinicaltrials.gov; NCT01638715

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Doripenem is a broad-spectrum parenteral carbapenem with enhanced activity against and Current dosing regimens recommend the administration of 0.25 to 0.5 g once daily in patients undergoing intermittent renal replacement therapy. As patients are usually dialyzed thrice weekly, we aimed to investigate a 1-g posthemodialysis regimen, thus reducing treatment costs and enhancing patient compliance. A second objective of this trial was to describe the pharmacokinetics of intradialytic doripenem. Ten oliguric or anuric patients in need of intermittent renal replacement therapy were included in this trial. All patients suffered from a septic episode. The mean hemofilter clearance was 123.46 ± 42.03 ml/min, and the total body clearance between hemodialysis sessions was 16.79 ± 6.02 ml/min. The average prehemodialysis trough concentration was 2.4 ± 1.3 mg/liter, while the EUCAST resistance breakpoint for is set at 2 mg/liter. The interpatient variability was considerably higher than the intrapatient variability. Apart from one patient who suffered an allergic reaction, doripenem was tolerated well by all patients. Our data indicate that posthemodialysis administration of 1 g of doripenem results in sufficient plasma levels in anuric but not oliguric patients during the entire dosing interval. (This trial was registered with EudraCT under registration no. 2009-018010-18 and at ClinicalTrials.gov under registration no. NCT02018939.).

Musculoskeletal (MSK) diseases affect a substantial proportion of the population. Specialist consultations were offered at the workplace for people with musculoskeletal (MSK)-complaints. We analyzed data on pain and well-being as well as health economic data at baseline. Lasting effects of the consultation were analyzed at a follow-up-interview after 12 months. Baseline data of 344 individuals were available. Occupations were divided into physically highly demanding (HD) or less demanding. Women reported significantly higher pain levels and less QoL than men. Sick leave days were significantly more in HD-workers. Independent of workload, significantly higher percentages of women had cervical- and upper limb-pain than men, with significantly higher pain in upper limbs in HD-workers. 235 participants were available for telephone-follow-up. QoL and MSK-pain improved significantly. Yearly out-of-pocket spendings for treatments significantly increased. NSAID use significantly decreased, whereas use of non-drug musculoskeletal-medical-services was significantly higher after one year. Regarding MSK-symptoms in gainfully employed individuals, the study showed significantly different workload-dependent differences in QoL. Significant effects of a consultation by a MSK-specialist were shown in terms of improved MSK-pain and overall well-being. This workplace-centered consultation had significant effects on beneficial health-behavior such as decreased use of NSAID and increased engagement in gymnastics and physiotherapy.

Aims: Radiographic imaging is essential in the diagnosis of hand osteoarthritis (HOA); however, it is unknown whether a multiplanar examination would add essential information to dorso-palmar (dp) views alone. This study evaluated whether an additional radiographic view would aid clinicians in the diagnostic process of HOA. Methods: The dp radiographs of both hands from 159 HOA patients were assessed according to the scores described by Kellgren and Lawrence (K/L). In oblique view images, structures similar to classic ostophytes (OPs) were found, namely bony proliferations on the dorsal and/or ventral margins of joints, and were documented as dorsal/ventral OPs (dvOPs). Function and pain were assessed by applying standardised read-out systems. Logistic regression analysis and Mann–Whitney tests were implemented. Results: The presence of dvOPs was associated with the degree of joint damage; however, dp views were sufficient to estimate radiographic changes. Only a few joints showed dvOPs as the only structural alteration; nevertheless, in almost all cases, classical radiographic OA changes were found in dp views of other joints of the same or the contralateral hand. The presence of dvOPs did not affect joint function or pain according to established scores, but was associated with radiographic progression in distal interphalangeal joints. Conclusion: This is the first study to confirm that additional radiographic planes, oblique/lateral views, are not necessary in the diagnostic process in HOA in daily clinical practice. Nevertheless, the presence of dvOPs reflect more severe joint damage and is associated with radiographic progression in HOA; hence, oblique/lateral views could be a useful tool for academic purposes.

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Background:The apathogenic and highly prevalent Torque Teno Virus (TTV) is associated with the immunocompetence of its host and has been proposed for immunologic monitoring in solid organ transplantation.Objectives:Herein we explore TTV levels in rheumatoid arthritis (RA) patients receiving biological disease-modifying anti-rheumatic drugs (bDMARDs) in the context of clinical response.Methods:The BIOBIO study was designed to evaluate biomarkers for prediction of clinical response in patients with RA. Within this multicentre open-label trial, patients with insufficient response to MTX were randomized to TNFi (infliximab; INF), anti-IL-6 receptor (tocilizumab; TCZ), CTLA4-Ig (abatacept; ABA) or anti-CD20 (rituximab; RTX) in addition to MTX. TTV in peripheral blood samples was quantified at baseline and 3 months by RT-PCR.Results:TTV was measured in 95 RA patients [INF (n=23), TCZ (n=22), ABA (n=27) or RTX (n=23)]. Median TTV levels at baseline were 4.2x104 c/ml with no difference between the treatment groups. After 3 months of treatment patients with INF (p=0.018), ABA (p=0.071) and RTX (p≤0.001) showed an increase in TTV levels compared to baseline. There was no change in TTV in patients with TCZ, who were omitted from further analyses. TTV at 3 months after treatment was higher in patients achieving a SDAI85 response at month 6 (p=0.019). Levels of above 5.6x105 c/ml at month 3 showed a 67% specificity and 81% sensitivity for a SDAI85 response at month 6, corresponding to a positive likelihood ratio of 2.6 (95% CI: 1.6-4.1). Patients in the top tertile of month 3 TTV (>7.8x105 c/ml) had lower SDAI, CDAI and DAS28 and higher SDAI85 response rates at month 6 (OR: 4.18, CI: 1.41-16.42; p=0.012). The highest non-response rates were found in patients within the lowest TTV tertile (Table A), and the highest remission rates were found in the highest TTV tertile (Table B). No patient below a TTV value of 2.7x104 c/ml at month 3 showed SDAI85 treatment response at month 6.Conclusion:Our data suggest that TTV levels in patients with RA treated with INF, ABA or RTX at month 3 are associated with clinical responses at month 6, and thus may constitute a biomarker for therapeutic monitoring.Abstract THU0101 –Table 1Acknowledgement:This study was supported by a grant of the Austrian Science Funds (FWF, grant-ID: KLI072)Disclosure of Interests:Paul Studenic: None declared, Gregor Bond: None declared, Andreas Kerschbaumer Speakers bureau: Bristol-Myers-Squibb, Celgene, Pfizer, Manuel Becede: None declared, Karel Pavelka: None declared, Dmitry Karateev: None declared, Jutta Stieger: None declared, Rudolf Puchner: None declared, Rudiger Muller: None declared, Elisabeth Puchhammer-Stöckl: None declared, Martina Durechova: None declared, Michaela Loiskandl: None declared, Thomas Perkmann: None declared, Marta Olejárova: None declared, Elena Luchikhina: None declared, Carl-Walter Steiner: None declared, Michael Bonelli: None declared, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, MSD, Pfizer Inc, Roche, Consu...