Clinical characteristics of antitumor necrosis factor (TNF) agents-related tuberculosis (TB) in ankylosing spondylitis (AS) are not well described. The aim was to compare the incidences and the characteristics of TB in AS and rheumatoid arthritis (RA) during TNF inhibitor treatment. AS (n = 1,322) and RA (n = 3,154) patients who received medical care between January 2001 and August 2011 were enrolled. The incidence of TB in patients treated, or not, with TNF inhibitors and the clinical features associated with TB were explored. Seven patients with AS and seven with RA developed TB while receiving TNF inhibitor therapy, resulting in an incidence rate of 600.2/100,000 person-years (PYs) (95 % confidence interval (CI), 241.3-1236.3) for those with AS and 771.6/100,000 PYs (95 % CI, 310.2-1589.9) for those with RA. Incidence rate ratios for TNF inhibitor-treated vs. untreated patients were 4.87 for AS (95 % CI, 1.50-15.39; p < 0.001) and 3.61 for RA (95 % CI, 1.38-8.07; p < 0.001). Low body mass index was identified as a significant risk factor for TB in the AS group (odds ratio (OR), 13.0; p = 0.002). Extrapulmonary TB was predominant at 85.7 % during TNF inhibitor treatment. Three (42.8 %) of the AS patients, but none of the RA patients, developed TB with concomitant isoniazid. All AS patients recovered from TB whereas two of seven RA patients died. Treatment with TNF inhibitors significantly increases the risk of extrapulmonary TB in AS. Symptoms of infection should warrant clinicians to evaluate for TB during TNF inhibitor therapy in AS patients.

BackgroundDose reduction of etanercept after clinical remission in patients with ankylosing spondylitis (AS) is not uncommon practice. However, efficacy and optimal schedule of dose tapering is rarely evaluated.ObjectivesTo investigate the efficacy and safety of low dose etanercept treatment (25mg or less/week) after clinical remission of AS in real world.MethodsIn this study, 134 AS patients who treated with etanercept for at least 12 months and achieved clinical remission (BASDAI <4 and normal C-reactive protein level) between 2004 and 2013 were enrolled. Dose reduction was performed in 100 patients (low dose group) after achieving clinical remission based on physician's medical decision. Other 34 patients (standard dose group) maintained the dosage of 50mg/week until discontinuation. Drug survival (time to drug discontinuation due to inefficacy or adverse event) and incidence of significant adverse events were compared between two groups. In patients with low dose group, clinical factors and time to dose reduction associated with longer drug survival were estimated.ResultsClinical and demographic features were comparable between two groups at the time of starting etanercept except for age (43.4 years in low dose group vs. 52.0 years in standard dose group, p=0.001). In low dose group, median time to dose reduction was 19.5 (10.1-39.6) weeks. During 536.8 person-years (PYs) of follow up, 27 patients stopped etanercept (21/440.9PYs in low dose group and 6/95.9PYs in standard dose group). Crude drug survival of low dose group was not significantly different from that of standard group (98.0% vs. 93.5% at 2 years, 92.1% vs. 89.4% at 3 years and 84.4% vs. 76.2% at 4 years). This finding was consistent after adjustment of clinical factors including age, gender, disease duration, initial BASDAI, concomitant MTX and previous TNF-blocker use (adjusted HR=0.552, 95% C.I. 0.208-1.465) (Figure). Incidence of adverse events which led to discontinuation of etanercept also showed no difference between two groups (40.82/1000PYs in low dose group vs. 52.16/1000PYs in standard dose group, p=0.783). In the subgroup analysis with low dose group, dose reduction after more than 24 weeks of standard dose treatment was significantly associated with longer drug survival after adjustment of other clinical factors (adjusted HR 0.273, 95% C.I. 0.085-0.875).ConclusionsIn patients with AS who achieved clinical remission, low dose etanercept treatment showed comparable long-term efficacy and safety in real world. Among various strategies of dose reduction, more than 24 weeks of standard dose treatment before adjustment was associated with longer drug survival.Disclosure of InterestNone declared

Purpose: The purpose of this predictive study was to identify factors affecting health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA). Methods: The participants in this study were 131 patients with RA who were recruited from the outpatient clinic of a university hospital in Seoul. Disease activity in rheumatoid arthritis was evaluated by calculating the Disease Activity Score 28. Disability in activities of daily living (ADL) was assessed with the Korean Health Assessment Questionnaire, and depression with The Center for Epidemiologic Studies Depression Scale. HRQoL was evaluated using The Short Form 36 Health Survey. Data were analyzed using descriptive statistics, correlation, and hierarchical multiple regression. Results: Pain, disability in ADL, disease activity, and depression correlated negatively with physical and mental dimensions of HRQoL. But hierachical multiple regression analysis revealed that disability in ADL and depression were the only variables negatively influencing physical and mental QoL after adjustment for influences of sociodemographic variables. Conclusion: Results of this study suggest that disability in ADL and depression, rather than disease activity and pain have profound effects on HRQoL in patients with RA. Further studies are needed to assess the predictive ability of disease activity and pain on HRQoL in this population.

Objective. The increase in mortality in rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) is well known. However, there are few studies on serum markers that can evaluate acute exacerbation or prognosis in RA-ILD patients. The purpose of this study was to identify the association between biomarkers and lung lesions in patients with RA-ILD. Methods. We analyzed 153 patients with serum samples in a prospective, multicenter cohort of Korean RA-ILD patients. The serum levels of biomarkers, matrix metalloproteinase (MMP-7), surfactant protein-D (SP-D), and Krebs von den Lungen-6 (KL-6) were measured and correlated with forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLCO) and the results of computed tomography (CT). CT results were interpreted semi-quantitatively according to the extent of lung lesions (