J.-S. Song

THU0515 Increased Carotid Intima-Media Thickness Was Related with Elevated Serum Homocysteine Level in Patients with Hyperuricemia

Background Hyperuricemia is known to be associated with metabolic syndrome and cardiovascular disease (CVD). It was reported that elevated level of homocysteine (Hcy) in patients with gout was related with decreased renal function. A high level of Hcy is regarded as a risk factor for CVD, since Hcy is related with endothelial cell damage, which can lead to inflammation in the blood vessels and atherosclerosis. However, there was no report about the relationship between Hcy and atherosclerosis in patients with hyperuricemia. Objectives In this study, we investigated whether or not carotid intima-media thickness (IMT) was increased in patients with hyperuricemia. We also evaluated the correlation between serum Hcy level and carotid IMT in hyperuricemic patients. Methods This study includes 1,228 patients who visited the Health Promotion Center of Chung-Ang University Hospital from January 2013 to August 2015. Serum Hcy, uric acid, fasting glucose, blood urea nitrogen (BUN) and creatinine (Cr), cholesterol profiles, C-reactive protein (CRP) and other laboratory findings were tested. Serum Hcy level was measured by a competitive immunoassay using direct chemiluminescent (Siemens Centaur Immunoassay Systems, USA). Carotid IMT was measured by B-mode carotid ultrasonography. Hyperuricemia was defined as the serum uric acid above 7.0 mg/dL, and hyperhomocysteinemia was defined as the serum Hcy above 15.0 μmol/L. Results The mean ages of hyperuricemic and normouricemic patients were not significantly different (51.19 ± 15.08 vs. 51.57 ± 17.01, p=0.833), however, the male ratio in hyperuricemia group was higher than that in normouricemia group (160/167, 96% vs. 732/1,061, 69%, p <0.001). Patients with hyperuricemia showed significantly higher levels in serum Hcy than normouricemic individuals (13.65 ± 4.47 μmol/L vs 11.68 ± 3.65 μmol/L, p<0.001). Carotid IMT in hyperuricemia group was significantly thicker than that in normouricemia group (1.13 ± 0.66 mm vs 1.03 ± 0.53, p =0.029). In patients with hyperuricemia, carotid IMT was correlated with serum Hcy level (γ=0.209, p=0.007), estimated glomerular filtration rate (eGFR), serum BUN and Cr levels (γ= -0.318, p<0.001; γ=0.229, p=0.003; γ=0.311, p<0.001, respectively), however, it was not correlated with serum uric acid level, glucose level and cholesterol profiles. It was shown that serum Hcy level was correlated with eGFR, serum BUN and Cr levels in hyperuricemic patients (r= -0.490, p<0.001; r=0.369, p<0.001; r=0.487, p<0.001, respectively), whereas it was uncorrelated with cholesterol profiles. The patients with high serum Hcy showed higher level of IMT than the patients with low serum Hcy (1.18 ± 0.68 mm vs 1.02 ± 0.52 mm, p<0.001). In multiple linear analyses, carotid IMT was affected by eGFR (β= -0.289, p=0.001), however, it was not influenced by glucose level and cholesterol profiles in patients with hyperuricema. Conclusions Carotid IMT was higher in patients with hyperuricemia than in those with normouricemia, and it was correlated with serum Hcy level in patients with hyperuricemia. This study suggests that decreased renal function in patients with hyperuricemia leads to elevated serum Hcy level, which in turn leads to atherosclerosis. Disclosure of Interest None declared

SAT0286 Monthly Ibandronate Reduces Bone Loss in Osteopenic Women with Rheumatoid Arthritis Receiving Long-Term Glucocorticoids: A 48-Week Double-Blinded Randomized Placebo-Controlled Investigator-Initiated Trial

Background Long-term use of glucocorticoids (GC) is problematic for patients with increased risk for vertebral fractures, especially those with rheumatoid arthritis (RA). Thus, prevention of GC-induced osteoporosis (GIOP) with bisphosphonates has now become an important strategy for reducing morbidity in RA patients. Ibandronate is indicated for the treatment and prevention of osteoporosis in postmenopausal women. However, evidence for ibandronate in GIOP prevention has been insufficient to date. Objectives To investigate efficacy of monthly ibandronate in RA women with reduced bone mineral density receiving long-term GCs Methods Female RA patients meeting the 1987 ACR classification criteria were enrolled in this 48-week double-blinded randomized placebo-controlled trial (clinicaltrials.gov NCT01287533). Patients that had taken GC (prednisolone-equivalent dose of ≥5 mg) for 3 or more consecutive months and fulfilling L1-4 T-score of < -1.0 and ≥ -2.5 by dual-energy X-ray absorptiometry were enrolled in this study. Patients were divided into 2 groups: 150 mg ibandronate versus placebo po every 4 weeks. Both groups were provided with daily 1500 mg of calcium carbonate and cholecalciferol of 400 IU. The primary end point was to compare the % changes of the L1-4 T-score at 48 weeks compared with baseline. Results Two hundred eleven patients from 13 centers nationwide participated in this study. One hundred sixty seven patients were randomized. The mean age of patients in the ibandronate and placebo group were 54.5 and 55.1 years, respectively. Baseline characteristics were not dissimilar between the 2 groups. The result of the primary endpoint is shown below (table). Serum C-terminal telopeptide was significantly reduced at 48 weeks in the ibandronate group. There was no incident of fracture in both groups during the study period. Safety profiles including adverse events were comparable between the 2 groups. Conclusions Monthly ibandronate for 48 weeks is effective in reducing bone loss in RA women on long-term glucocorticoids. Longer follow-up studies would be needed to investigate the effect on fracture prevention. Acknowledgements We would like to thank CTC bio for manufacturing the placebo, and Mr. Je-suk Kim for aiding statistical analyses. Disclosure of Interest None declared

SAT0323 Two-Year Follow-Up Study of the Relationship Between Serum Homocysteine, Uric Acid and Renal Function in Gouty Patients

Background Gout is known to be associated with metabolic syndrome and cardiovascular disease (CVD), which are major cause of increasing mortality in gouty patients. Homocysteine (Hcy) is related with endothelial cell damage and is regarded as an important risk factor for CVD. Although both hyperhomocysteinemia and gout are closely related to CVD, the only few cases about serum Hcy in gouty patients have been reported. Objectives We investigated the associations between serum Hcy level and the other parameters such as serum uric acid level, renal function, and cholesterol profiles in gouty patients with 2 year follow-up data. Methods Ninety-one male patients with gout and 97 age-matched healthy male controls were included in this study. The average age of each was 51.19±15.08 and 51.57±17.01 years old, respectively. Among them, 33 patients with gout and 39 healthy controls underwent follow-up tests for Hcy levels with 24.00±9.12 months on average. Serum Hcy levels were measured by a competitive immunoassay using direct chemiluminescent. The estimated glomurular filtration rate (eGFR) was calculated using modification of diet in renal disease equation, and then chronic kidney disease (CKD) was defined as an eGFR below 60 ml/min/1.73m2. Results Patients with gout showed significantly higher levels in serum Hcy than those in controls (13.96±4.05 μmol/L vs 12.67±3.51 μmol/L, p=0.022). However there was no significant difference between gouty patients and controls in the serum uric acid level (6.15±2.23 mg/dL vs 5.82±1.22 mg/dL, p=0.214). In patients with gout, serum Hcy level was negatively correlated with eGFR (γ=-0.413, p<0.001), while it was uncorrelated with serum uric acid levels or cholesterol profiles. Serum Hcy levels were not different between the groups treated with allopurinol and with benzbromarone. When we observed the follow-up results in gouty group, the change of serum Hcy level was positively correlated with the change of serum creatinine level (γ=0.560, p<0.001), and negatively correlated with the change of eGFR (γ=-0.556, p<0.001). However the change of serum Hcy level was uncorrelated with the changes of uric acid level or the lipid profiles. The gouty patients with CKD showed significantly higher serum Hcy level than those without CKD (17.45±4.68 μmol/L vs 13.15±3.46 μmol/L, p<0.001), and the follow-up result also showed similar tendency (19.12±4.29 μmol/L vs 15.69±5.73 μmol/L, p=0.059). In multiple linear analyses, serum Hcy level was affected by eGFR (β=-0.385, p<0.001), however, was not affected by the serum uric acid level. Conclusions Serum Hcy level was elevated in gouty patients than in controls. The change of serum Hcy level was negatively correlated with the change of eGFR. High level of serum Hcy in gouty patients was related with decreased renal function, and was not with serum uric acid or lipid profiles. Disclosure of Interest None declared

SAT0309 The Utility of Spot Urine Uric Acid to Creatinine Ratio for Predictor of 24-Hour Urine Uric Acid Excretion in Gouty Patients

Background Gout is an inflammatory disease resulted from hyperuricemia. The measurement of 24-hour urine uric acid excretion is important not only to evaluate the disease status but also to choose the kind of uric acid lowering agents. 24-hour urine collection, however, is cumbersome, inconvenient, and often unreliable because of errors in collection. The average person excretes approximately 1 g of creatinine per day, and a lot of studies showed that the spot urine protein to creatinine ratio was correlated with 24-hour urine protein excretion. Objectives In this study, we investigated the utility of the spot urine uric acid to creatinine ratio for predicting 24-hour urine uric acid excretion in gouty patients. Methods Fifty-one gouty patients without any use of uric acid lowering agents were enrolled in this study. The average age was 48.1±17.1 years old and 90.2% (46/51) were male patients. 24-hour urine collections of the patients were conducted to the evaluate uric acid excretion and renal function. Spot urine uric acid and creatinine specimens were obtained from all participants at the same day when 24-hour urine was collected. The creatinine clearance (CCr) was measured from the 24-hour urine collected sample, and chronic kidney disease was defined when their CCr level was below 60 ml/min/1.73m2. Results The mean of 24-hour uric acid excretion was 643.5±259.2 mg, and those of serum uric acid levels and CCr values were 7.45±1.35 mg/dl and 103.5±41.8 ml/min/1.73m2, respectively. Spot urine uric acid to creatinine ratio was significantly correlated with the absolute and log transformed 24-hour urinary uric acid values (γ =0.410, p =0.003; γ =0.610, p <0.001, respectively). In the linear regression analysis, the amount of absolute 24-hour urine uric acid excretion was estimated by 0.799 x (spot urine uric acid to creatinine ratio) + 336.239 (R2 =0.410, p =0.003). The correlation between spot urine uric acid to creatinine ratio and 24-hour urine uric acid excretion was also found in the patients with chronic kidney disease (γ =0.964, p <0.001). Conclusions Spot urine uric acid to creatinine ratio showed well correlation with the absolute and log transformed 24-hour urine uric acid excretions. The spot urine uric acid to creatinine ratio could be a good predictor of 24-hour urine uric acid excretion in gouty patients. Disclosure of Interest None declared

FRI0319 Value of Goal Directed Urate Lowering Therapy in Slowing the Progression of Renal Disease in Hyperuricemic Patients with Chronic Kidney Disease

Background Although uric acid has been known to exert a role in the progression of chronic kidney disease (CKD), only a few studies evaluated the renoprotective role of urate lowering therapy (ULT) in patients with hyperuricemia and CKD Objectives To determine whether ULT could delay the renal disease progression in hyperuricemic patients with CKD Methods We performed a retrospective review of hyperuricemic patients with stage 3 CKD followed from September 2005 to July 2014 in Dongguk University Ilsan Hospital, Goyang, Korea. A total of 158 eligible patients were identified and 65 of them were treated with ULT in addition to usual CKD management. We divided the patients according to the use of ULT and compared the estimated glomerular filtration rate (eGFR) change from baseline value and the proportion of renal disease progression (decline of eGFR greater than 30% of the baseline value, initiation of dialysis or eGFR <15 mL/min/1.73m2) at the time of last follow-up. Risk factors for renal disease progression were identified by logistic regression analysis. Results After 1050±759 days of follow-up, the ULT group showed better outcomes compared to non-ULT group in terms of eGFR change from baseline (-1.19±12.07 vs. -7.37±11.17 mL/min/1.73m2, p=0.001) and the proportion of renal disease progression (12.3% vs. 27.9%, p=0.019). Goal directed ULT showed better clinical outcomes compared to maintaining the initial ULT dose. Mean serum uric acid was significantly associated with the risk of renal disease progression (P for trend=0.04) and mean serum uric acid level <7 mg/dL reduced the risk of renal disease progression by 69.4%. Conclusions ULT significantly delayed the renal disease progression in hyperuricemic patients with CKD. Goal-directed ULT seems to be better than continuing the initial ULT prescription. Disclosure of Interest None declared

AB0519 Relationship between Various Psychological Problems with the Disease Activity or Damage Indices in Patients with Sle

Background Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which almost every organ may be affected. Various psychological problems are associated with systemic conditions, but the influence of SLE is still a matter of discussion. Objectives We evaluated depression, anxiety, anger, fatigue and quality of life in patients with SLE, compared to healthy controls. We also investigated the relationship between these psychological problems, disease activity and damage in patients with SLE. Methods 108 patients with SLE and 52 healthy controls completed a psychological questionnaire. Psychological parameters were assessed as follows: depression, Center for Epidemiologic Studies Depression Scale (CES-D); anxiety, Hospital Anxiety and Depression Scale (HADS); anger, State Trait Anger Expression Inventory (STAXI); fatigue, the Profile of Mood States fatigue-inertia scale (POM); quality of life (QOL), Functional Assessment Chronic Illness Therapy (FACIT). Disease activity and damage indices were measured by the SLE Disease Activity Index (SLEDAI) and the SLE Collaborating Clinics/American College of Rheumatology (SLICC/ACR), respectively. Results Patients with SLE showed higher symptoms of depression, anxiety, anger and fatigue (p=0.005; p=0.057; p=0.044; p=0.020, respectively), and lower level of QOL (p=0.003) than healthy controls. In the patients with SLE, mood symptoms such as depression, anxiety, and anger were correlated with each other (depression and anxiety: r=0.710, p<0.001; depression and anger: r=0.602, p<0.001; anxiety and anger: r=0.546, p<0.001). Fatigue and QOL were closely correlated with mood symptoms, respectively. The patients with higher prednisolone use (>7.5 mg/day) showed higher levels of depression, anxiety, anger and fatigue (p=0.002; p=0.022; p=0.027; p=0.010, respectively), and lower level of QOL (p=0.001) than the patients with lower prednisolone use (≤7.5mg/day). However, there were no significant differences in evaluating these parameters according to disease activity or damage indices. Conclusions The patients with SLE had higher levels of depression, anger and fatigue and lower level of QOL compared to healthy controls. Psychological parameters were affected by daily glucocorticoid dose rather than disease activity or damage indices. These findings suggested that the comprehensive evaluation of the various psychological problems could be helpful to SLE patients, especially those with higher doses of glucocorticoid, even if disease activity and damage are not severe. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4112

SAT0523 The Usefulness of Procalcitonin for Differentiating Acute Gout Arthritis from Infectious Disease

Background Acute gout arthritis is usually accompanied by tenderness, swelling, redness and fever. These features and laboratory findings including leukocytosis, elevation of serum ESR or CRP levels, are similar to those of infectious diseases. Moreover, normal to low serum uric acid levels have been noted in many cases of acute gout arthritis. For these reasons, the differential diagnosis of acute gout arthritis with infectious disease can be difficult. Objectives Procalcitonin, the precursor peptide of calcitonin, is known to be elevated in the patients with bacterial infection. We investigate whether or not serum procalcitonin levels are higher in patients with acute gout arthritis than in the others. We also evaluate the usefulness of procalcitonin for differentiating diagnosis between acute gout arthritis and bacterial infection. Methods The serum samples were obtained from 67 patients with acute gout arthritis and 90 age-matched patients with bacterial infection. Serum procalcitonin levels were measured by an enzyme-linked fluorescent assay. Results The serum procalcitonin levels in patients with acute gouty arthritis were significantly lower than those in patients with bacterial infection (0.096±0.105 ng/mL vs 4.941±13.763 ng/mL, p =0.001). However, other inflammatory parameters, such as ESR, CRP and WBC, showed no significant differences between these two groups. Patients with acute gout arthritis had statistically higher serum uric acid levels than the patients with bacterial infection (7.62±2.03 mg/dL vs 5.19±2.36 mg/dL, p<0.001); however, 19.4% (13/67) among the acute gout arthritis group had lower uric acid level (below 6.0 mg/dL). To determine the discriminative ability of procalcitonin between acute gout arthritis and bacterial infection, we conducted ROC analysis about procalcitonin, uric acid, ESR, CRP and WBC. The area under the curve (AUC) of procalcitonin and uric acid were 0.852 (95% CI 0.793-0.911, p<0.001) and 0.808 (95% CI 0.738-878, p<0.001), respectively. There was no significance at ESR, CRP and WBC. With a cut off value of 0.095 ng/dL, the sum of sensitivity and specificity of procalcitonin were the highest (80.0% and 80.6%, respectively). Conclusions Serum procalcitonin levels were significantly lower in patient with acute gout arthritis than in patients with bacterial infection. The serum procalcitonin level is expected to be a useful serologic marker for the differentiating acute gout arthritis from bacterial infection. References Simon L et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004:39:206-17. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4127