Camelia Pana

Renal disease in patients with rheumatoid arthritis treated with biological therapy

Abstract The use of biological therapies may have positive impact on chronic renal disease associated with rheumatoid arthritis. The study evaluates retrospectively renal function in 57 patients with rheumatoid arthritis treated with different types of biological therapy, comparative with 62 RA patients treated conservatively with DMARDs. Patients treated with biological therapies presented a lower mean value for serum creatinine measured both at baseline and after 6 months of treatment, statistically significant compared with the subgroup treated with DMARDs (0.69 ± 0.17 mg/dL vs. 1.18 ± 1.01 mg/dL, p = 0.003). Results for estimated filtration rate were significantly increased in biologically treated cohort (100.36 ± 16.76 mL/min/1.73 m2 vs. 63.49 ± 21.60 mL/min/1.73 m2, p < 0.00001). Rituximab presented a better estimated filtration rate compared with other biological tharapies (eGFR 97.037 mL/min/1.73 m2 vs. 90.933 mL/min/1.73 m2). The positive effect of potent biological anti-inflammatory therapies sustains the need of further exploring the risk of reduced kidney function in immune-mediated diseases, including rheumatoid arthritis.

17 Years Old Patient with Nephritic Syndrome Induced by Systemic Lupus Erythematosus

The case study describes the admission of a 17 years old patient in the emergency department of Constanta with main complaints: diffuse abdominal pain, poly arthralgia and intense headache. The first screening tests revealed anaemia, renal impairment associated with nephritic syndrome. In the immunological investigations, the level of antibodies anti-ds DNA was increased and the following renal biopsy presented segmental changes of the glomerular membranes. The clinical features associated with the laboratory results were specific for the diagnosis of systemic lupus erythematosus. The patient was continuously under follow-up and was given mainly antihypertensive drugs and corticosteroids. She also received treatment for correction of anaemia and analgesia. In conclusion, this patient with a newly diagnosed autoimmune disorder was presented with deteriorating renal function associated with hypertension, conditions which appear very rarely in patients of such a young age.

Renal comorbidity in psoriatic arthritis patients

Abstract Introduction. Psoriatic arthritis (PA) is a multi-system inflammatory disorder that involves both musculoskeletal structures (joints, enthesis, tendons) and the skin and nails (psoriasis). Clinical manifestations can be varied from clinically asymptomatic disease to arthritis mutilans and invalidating forms. Purpose. Identification of renal disease in patients with psoriatic arthritis depending on the degree of activity and severity of skin and joint disease. Material and Methods. We conducted a retrospective study of 89 patients diagnosed with psoriatic arthritis in the Rheumatology Department of Clinical Emergency Hospital “Sf. Andrei” in Constanta. We collected demographic and behavioural data (age, sex, ethnicity, smoking), clinical and biological elements of joint and skin disease activity (number of painful and swollen joints, joint pain score - VAS, PASI score, ESR, CRP) and evaluation of renal function (serum creatinine, serum uric acid, urinalysis examination for proteinuria and hematuria). Chronic kidney disease was staged by calculating the value of glomerular filtration rate (GFR) with CKD-EPI 2009 equation. Results. 49 patients have full screening of renal function, especially in disease onset or in case of therapy switch. Proteinuria was found in a significant percentage of patients (32.65%), vary widely between 10-500 mg/dL. Chronic kidney disease (CKD) was commonly found in our patients (42.85%), mostly in women (66.6%). Most cases of CKD were in stage 2 (12.4%). We observed a significant correlation between age and levels of serum creatinine (p = 0.041), caucasians developing more frequently CKD (p <0.0001). The presence of skin psoriasis did not interfere with renal function decline in PA patients, but its severity, measured with PASI score, was correlated with cronic kidney failure stages (p = 0.05) and proteinuria (p = 0.044). The severity of joint pain (TJC, VAS) is directly related to kidney disease (p <0.0001, respectively p = 0.05). The majority of patients with extensive joint erosions also had renal impairment (p = NS) and it can be seen a direct correlation between erosive joint disease and serum creatinine (p = 0.029). Conclusions: Both the severity of psoriasis and articular disease may be involved in worsening of renal function, probably due to the chronic systemic inflammation and to an aggressive therapy imposed by the disease evolution.

SAT0383 The Functionl Impact of Asymptomatic Axial Involvement in Psoriatic Arthritis

Background Spondylitis associated with peripheral psoriatic arthritis occurs in 40% to 70% of the patients, depending on whether or not radiographs are taken (1). Careful clinical and radiologic assessment, however, reveals involvement of the axial spine in 20% to 40% of cases, increasing to as many as 51% at long-term follow-up (2). Involvement of the sacroiliac joints can be symmetric or asymmetric. During follow-up,although the radiographic changes in the spine tend to progress,spinal mobility is preserved or improves, and this form of spinal disease carries a better prognosis than pure ankylosing spondylitis.(2) Queiro et al had reported asymptomatic spondilitis in 20% of patients with psoriatic arthritis (PA), and Taylor et al had reported a higher frequency of radiological lesions without symptoms (3,4,5). Objectives To identify the functional impact of asymtomatic axial involvement in patients with PA Methods 88 PA patients (59.1%, women, mean age 55.53±11.06 years, mean of PA duration about 12.49±11.61 years) were included. Patients were assessed as followings: demographical, medical history, a clinical assessment for joint disease (activity score like BASDAI, functional score like BASFI, mobility score like BASMI and classical indices) and an radiological assessment for progression (sacroiliac and vertebral according BASRI score).We have considered axial involvement the presence of sacroiliitis and/or vertebral spondylitis. Results We had noticed asymptomatic axial involvement in 13.63% (12 patients) patients, been 83% of them with sacroiliitis graded 3 and 4. Regarding functionality, BASFI had a mean about 3.77±2.33 (p=0.006) versus 6.29±2.71 in patients with lumbar pain and PA. Mobility is clearly better in patients with asymptomatic sacroiliitis: BASMI score (1±1.41, 3.23±3.01, p=0.008), Schober index (4.33±1.48, 3.35±2.32, p=0.003), chest expansion index (2.54±0.96, 2.40±1.38, p=NS), menton-stern index (2.5±1.5, 3.82±2.09, p=0.043). The activity score BASDAI had differences in groups with or without spinal pain (5.91±2.4, 4.16±1.9, p=0.028). The radiological score BASRI had any significant differences between groups (5.54±3.91, 5.64±3.19, p=NS). Conclusions Even asymptomatic, axial involvement is present and give them quiet spinal disability and severe radiological progression References Ritchlin C, Psoriatic and Reactive Arthritis, 2007. Hochberg, Rheumatology, 2011. Gladman DD et al, PA-an analysis of 220 patents, Q J Med 1987; 62:127-141. Gladman DD, Natural history of PA, Baillieres Clin Rheumatol 1994; 8: 379-394. Gladman DD et al,Psoriatic spondyloarthropathy in men and women: a clinical, radiographic and HLA study, Clin Invest Med 1992; 15: 371-375. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4389

AB0572 Additional risk for cardiovascular comorbidities in patients with psoriatic arthropathy

Background Cardiovascular(CV) comorbidities are an important issue of inflammatory arthritis (1.2), given that mortality increases with the severity form of the disease(3). CV risk factors and metabolic factors were present more frequent in patients with psoriatic arthritis(PA) than in controls (1,2,4). Psoriasis is considered by some authors as an independent risk factor for CV disease (5). So, like the newest published study, further study are needed to indicate whether inflammatory suppresion or modification of traditional CV risk factors will reduce CV risk (1). Objectives To assess presence of CV comorbidities and relation with CV risk factors in patients with PA Methods 88 patients diagnosed with AP CASPAR criteria were examined by medical history (demographic data), clinical (anthropometrical data, assessment of skin activity by PASI score), biological (blood glucose, lipid profile) and imaging (EEG, abdominal ultrasonography, cardio-thoracic radiography). The CV comorbidities were established by a cardiologist. The severe skin disease was considered with a PASI score over 10. Results 72.8% of patients were caucasians, 59.1% women, with a median age of 55.63 ± 11.16 (31-80) years. We analyzed the cohort starting from each known CV risk factors (age over 50 years, smoking status, obesity, dislipidemia) and extended skin damage. Age over 50 years and dislipidemia were associated with CV (ischemic heart disease 20-30%, p= 0.032; hypertension 54-56.7%, p=0.008) and metabolic disease (diabetes 31.7%, p=0.005; hepatic steatosis 28.3%, p=0.028). Only 28.6% of smokers have hypertension (p=0.038). Obese patients with AP shows CV disease, hypertension was present in 61.5% (p=0.07), and ischemic heart diseaseonly in 25.6% (p=0.067).38.5% of obese are diabetic patients (p=0.003) and 40% shows hepatic steatosis (p=0.01). Regarding patients with extensive skin involvement notice that 90% of these shows dyslipidemia (p = 0.012) and 80% hypertension (p = 0.027). The risk of developing hypertension given age was 50 years (RR=3.27), presence of diabetes (RR = 2.03), obesity (RR = 2.09), but especially severe skin damage (RR=6.65). The risk of developing ischemic heart disease was conferred by a family history of psoriasis (RR=2.32), presence of dyslipidemia (RR=1.31), presence of diabetes (RR=6.4), presence of obesity (RR=2.2) and in a small extent the score PASI(RR=1.31). Conclusions Besides the recognized CV risk factors(age, obesity, smoke, dislipidemia), psoriasis is an additional and significant risk factor for CV comorbidities in patients with psoriatic arthropathy. References Jamnitski A et al, CV comorbidities in patients with psoriatic arthritis, AnnRheumDis, 2013, 72: 211-6 Soltani-ArabshahiR et al, Obesity in early adulthood as a risk factor for psoriatic arthritis, Arch Dermatol. 2010 Jul;146(7):721-6. Arumugam R, McHugh NJ, Mortality and causes of death in psoriatic arthritis, J Rheumatol Suppl 2012, 89: 32-5 Love TJ et al, Obesity and the risk of psoriatic arthritis: a population-based study, Ann Rheum Dis. 2012 Jun 26. Ahlehoff O et al, Psoriasis is associated with clinically significant cardiovascular risk, J Intern Med 2011, 2011: 270: 147-57 Disclosure of Interest None Declared