AB0610 EARLY RHEUMATOID ARTHRITIS AND THYROID DYSFUNCTION: A 20-YEARS FOLLOW-UP STUDY IN BULGARIA

Background:Thyroid dysfunction is common in rheumatoid arthritis (RA). Subclinical hypothyroidism is the first most common, followed by clinical hypothyroidism. Thyroid dysfunction in RA had been found to increase the risk...

Background: Autoantibodies against the thyroid seem to be more common in patients with rheumatic diseases than in the normal population. Their appearance may be linked to an associated autoimmune thyroid disease. Knowing the degree of association between rheumatic and thyroid diseases may help the clinician to make the correct decision. Objectives: The aim of the work was to estimate the prevalence of thyroid autoantibodies among patients with systemic autoimmune rheumatic diseases with or without thyroid disorders and its association with disease activity and functional impairment. Patients and Methods: The current study included 60 patients and 20 healthy controls. Patients were divided into three groups; systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and systemic sclerosis (SSc). Clinical and laboratory assessment were done to all patients including routine laboratory investigations and thyroid function tests (thyroid stimulating hormone [TSH], T3 and T4), and thyroid autoantibodies; anti- thyroglobulin (TgAb) and anti-thyroperoxidase (TPOAb). Results: SLE group had significant (P=0.018) lower age than other groups. Antithyroid antibodies and thyroid disorders were more common in SSc and SLE patients than RA patients and control subjects; however, no significant difference between studied groups. Presence of autoantibodies with and without thyroid disorders was not associated with the activity or functional indexes evaluated. Conclusion: The prevalence of thyroid autoantibodies in SLE and SSc patients was higher than in RA patients. No link could be established between the presence of thyroid autoantibodies and the results from any of the instruments used to measure inflammatory activity and functional impairment in these cases of rheumatic diseases.

SAT0622 The Clinical Use of Digital Joint Space Width and X-Ray Radiogrammetry as Markers for Early Radiographic Progression in RA

AB1364 Death analysis of 144 rheumatoid arthritis patients over the last 24 years

The aggregation between AITD with rheumatologic, or dermatologic, autoimmune diseases

See Article on Page 656-663 Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology that is characterized by a hyperplastic synovial membrane capable of destroying adjacent articular cartilage and bone, which leads to disability and loss of quality of life [1]. Among these pathological processes, bone destruction is especially important because it is associated with functional impairment. Disease-modifying antirheumatic drugs (DMARDs) have been used widely to treat patients with RA. Unfortunately, in some RA patients, DMARDs do not slow disease progression. Introduction of biologic agents, such as tumor necrosis factor inhibitors, has caused a profound paradigm shift in the treatment of RA. Combined treatment of these drugs with methotrexate (MTX), the prototypical DMARD, has proven to be significantly superior to MTX alone for improving signs and symptoms, as well as inhibiting radiographic progression. The clinical efficacy of anticytokine therapies conf irms the critical role of proinf lammatory cytokines in the pathogenesis of RA. For such cytokines to cause inf lammation and thereby contribute to the development of RA, appropriate intracellular signaling should be activated in various immune cells. Members of the Janus kinase (JAK) family are essential for signaling by diverse cytokines crucially implicated in the pathogenesis of RA. Therefore, small-molecule inhibitors targeting the JAK pathway have been developed. Tofacitinib (CP-690,550) is an orally delivered small-molecule selective inhibitor of JAK1, JAK3 and, to a lesser extent, JAK2 [2]. Several clinical trials have evaluated the efficacy and safety of tofacitinib in active RA patients with inadequate responses to DMARDs or MTX [3,4,5,6,7]. Eventually, two phase 3 randomized controlled trials (RCTs) demonstrated the efficacy and safety of tofacitinib in RA patients with inadequate responses to DMARDs or MTX [6,7]. Hence, the Food and Drug Administration approved tofacitinib for use in such patients with insufficient responses or intolerance to MTX, at a recommended dosage of 5 mg twice daily [8]. Song et al. [9] recently performed a systematic review of RCTs, examining the efficacy and safety of tofacitinib in RA patients with an inadequate response to MTX or DMARDs. Their meta-analysis included f ive RCTs, including three phase 2 and two phase 3 trials, with a total of 1,590 patients. The three phase 2 RCTs included 452 RA patients (144 patients randomized to 5 mg of tofacitinib twice daily, 156 patients randomized to 10 mg of tofacitinib twice daily, and 152 randomized to placebo). The meta- analysis of the phase 2 studies demonstrated that the American College of Rheumatology (ACR) 20 response rate was significantly higher in patients receiving either dosage of tofacitinib compared with controls (relative risk [RR], 2.445; 95% confidence interval [CI], 1.229 to 4.861; p = 0.011; RR, 2.597; 95% CI, 1.514 to 4.455; p = 0.001). Safety outcomes did not differ among groups, except infection was more frequent in patients receiving 10 mg tofacitinib (RR, 2.133; 95% CI, 1.268 to 3.590; p = 0.004). Analysis of the two phase 3 trials (1,123 patients) confirmed these results. Collectively, they demonstrated that tofacitinib is effective in active RA patients with inadequate response to DMARDs or MTX and has a manageable safety profile. Very recently, Lee et al. [10] reported the findings of a phase 3 study comparing tofacitinib monotherapy to MTX monotherapy in patients with RA who had not previously received MTX or therapeutic doses of MTX. They randomly assigned 958 patients to receive 5 or 10 mg of tofacitinib twice daily or MTX (mean dose 18.5 mg/week). The coprimary efficacy endpoints were the mean change from baseline in the modified total Sharp score and the proportion of patients who achieved an ACR70 response, both assessed at 6 months. Surprisingly, the mean changes in the Sharp score were significantly smaller in patients receiving tofacitinib than in those receiving MTX, and these between-group differences persisted at months 12 and 24. Further, the proportion of patients in the tofacitinib groups with an ACR70 response lasting 24 months was greater than that in the MTX group. Taken together, these results suggest that tofacitinib might be superior to MTX as first-line monotherapy for inhibiting the progression of RA. In conclusion, tofacitinib is a novel oral JAK inhibitor developed as a targeted immunomodulator and disease-modifying therapy in RA. Tofacitinib, either alone or in combination with MTX, is effective in active RA patients with inadequate responses to DMARDs or MTX and has a manageable safety profile. In addition, it might be superior to MTX as first-line monotherapy for RA. However, long-term studies are required to define the efficacy and safety of tofacitinib in a large number of patients with active RA.

AB1350 Is the radiographic damage a risk factor for neuropathic pain in rheumatoid arthritis?

Objective To investigate the clinical characteristics and prognosis of rheumatic disease-associated episcleritis and scleritis. Methods The clinical and laboratory features of 20 in-patients with episcleritis or scleritis from September 2005 to July 2016 in Peking University People's Hospital were analyzed retrospectively. The data of 11 rheumatoid arthritis (RA) patients were compared with 33 RA patients without episcleritis or scleritis of similar gender composition and age presented in the same period. T test, Mann-Whitney U test, chi-square test and rank sum test were used for statistical analysis. Results Among the 20 patients, the average age was (58±15) years old. Episcleritis and scleritis each accounted for half. The spectrum of rheumatic diseases included, in the order of disease frequency, RA, systemic lupus erythematosus (SLE), systemic vasculitis, relapsing polychondritis (RP), ankylosing spondylitis (AS) and undifferentiated connective tissue disease (UCTD). RA and SLE patients accounted for 55% and 20% cases respectively. Episcleritis and scleritis occurred significantly earlier in lupus patients than RA patients [(2.1±1.4) year vs (16.3±12.7) year, t'=3.598, P<0.01]. RA patients with episcleritis or scleritis had higher platelet (PLT) count[(330±138)]×109/L vs (234±91)×109/L, t=2.652, P<0.05), higher X-ray scores (P<0.01), more bone erosion [(90%(10/11) vs 52%(17/33), χ2=3.9, P<0.05] and frequent pulmonary interstitial involvement [46%(15/33) vs 9%(1/11), χ2=5.1, P<0.05]. Among 20 patients, 18 patients received systemic glucocorticosteroid. Patients with sclera involvement received a significantly higher dose of corticosteroid than patients without sclera involvement [(17.1±16.8) mg/d vs (2.2±4.2) mg/d, t'=2.907, P<0.01]. Patients with scleritis received a significantly higher dose of cortico- steroid than patients with episcleritis [(31±14) mg/d vs (5±6) mg/d, t=-3.959, P<0.01]. Disease-modifying anti-rheumatic diseases (DMARDs) and immunosuppressive agents prescribe dincluded methotrexate (MTX), leflunomide (LEF), hydroxychloroquine (HCQ), cyclosporine A (CsA) and cyclophosphamide (CTX). One refractory case of scleritis recovered after the administration of TNF inhibitor agent. Steroids and NSAIDs eye-drops were administered as well. Conclusion Episcleritis and scleritis are relatively rare ocular diseases, which are commonly associated with rheumatic diseases. In patients with RA, the occurrence of episcleritis or scleritis may suggest severe diseases and other co-existing extraarticular manifestations. The scleral involvement in RA patients ismore resistant to treatment compared to SLE. Consideration must be given to both rheumatic diseases and ocular disorders when dealing with the treatment strategy. Key words: Scleritis; Autoimmune diseases; Arthritis, rheumatoid; Lupus erythemat-osus, systemic

FRI0179 Infliximab infusion reactions in patients with rheumatoid arthritis and spondylarthropathies

Background: One of the main cause of thyroid disease is autoimmune thyroid disease and anti thyroid peroxidase (TPO) antibodies is a major marker of the condition. There are very few studies in the country regarding the etiology of thyroid disorders and hence this study is being conducted for it.&#x0D; Methods: This is retrospective cross sectional study from 28 January 2019 to 29 July 2019 done at National Academy of Medical Sciences, Bir Hospital, Kathmandu. The laboratory serum sample data of all Anti TPO antibody results from patients seeking treatment at the instituition were analyzed for age and gender variation. Anti TPO antibody titre of equal or more than 34 IU/ml was considered as positive.&#x0D; Results: Out of 768 samples analysed for study, 79.9% were of women and 20.1 % were of men. A total of 205 (26.7%) were positive for anti TPO antibodies of which 83.4% were women and 16.6% were men . Women had more patients with anti TPO antibodies positive as compared men (27.9 vs 21.1%). Mean Anti TPO titre were also more in women as compared to men (61.01 vs 48.20 IU/ml).&#x0D; Conclusions: About one fourth of the patients had siginificant titers of anti TPO antibodies suggestive of thyroid autoimmunity. Both prevalence of positive anti TPO antibody titres and the mean anti TPO antibody titre values were more in women as compared to men. Further well designed larger community studies are required.

Anti-tumour necrosis factor (TNF) biologics have revolutionized therapy of rheumatoid arthritis (RA). We compared the effects of infliximab on numbers of circulating leucocyte subsets in early RA (disease/symptom duration of ≤1 year) and late RA patients (>1 year). A control group consisted of early RA patients treated with a combination of methotrexate (MTX) and methylprednisolone. Blood samples were obtained at baseline (pre-therapy) from all RA patients, divided into three groups: (i) late RA receiving infliximab/MTX, (ii) early RA-infliximab/MTX, (iii) early RA-steroid/MTX, and also from follow-up patients at 2 and 14 weeks. Significant differences in absolute counts of monocytes and granulocytes were observed between healthy controls and RA patients. At baseline CD14(bright) monocytes and CD16(+) granulocytes were increased in both early RA and late RA patients. CD4(+) T cells, CD8(+) T cells and B cells were all increased at baseline in early RA, but not in late RA. At 2 weeks following infliximab treatment decreased granulocytes were observed in both early and late RA and decreased natural killer (NK) cells in late RA. CD16(+) granulocytes and NK cells were also decreased at 14 weeks post-infliximab in early RA. Biotinylated infliximab was used to detect membrane-associated TNF (mTNF)-expressing leucocytes in RA patients. CD16(+) granulocytes, NK cells and CD14(dim) monocytes all expressed higher levels of mTNF in RA patients. In summary infliximab is associated with decreased CD16(+) granulocyte and NK cell counts, possibly through binding of mTNF. Differential effects of infliximab between early and late RA suggest that pathogenic mechanisms change as disease progresses.

BackgroundPatients with rheumatoid arthritis (RA) have an increased risk of cardiovascular (CV) disease. Monitoring of arterial stiffness could be used as an additional tool of cardiovascular risk assessment.Objectivesof the study...

AB1045 Efficacy of Etanercept on Radiographic Progression in Adult Patients with Rheumatoid Arthritis or Psoriatic Arthritis: Results from The Second Interim Analysis of A German Non-Interventional, Prospective, Multi-Center Study

Routine screening serum tests to detect underlying thyroid and autoimmune diseases in patients with moyamoya disease

SAT0609 Synovitis in Patients with Inflammatory Arthropathies: Comparison Between Rheumatoid Arthritis and Psoriatic Arthritis Evaluated by Power-Doppler Ultrasound