Kim Ys

Dual curing of cationic UV-curable clear and pigmented coating systems photosensitized by thioxanthone and anthracene

Abstract We investigated the effects of photosensitizers (2,4-diethylthioxanthone (DETX) and anthracene) and dual curing on the kinetic and physical properties of cationic photocurable clear and pigmented coatings based on cycloaliphatic diepoxide/ϵ-caprolactone polyol. The cationic photopolymerizations were investigated by Fourier-transform infrared spectroscopy with attenuated total internal reflection (FTIR-ATR), real-time infrared spectroscopy (RTIR), and differential scanning photocalorimetry (photo-DSC). The coatings were shown to polymerize in the dark due to the “living” character of cationic polymerization. Measurements of the yellowness index revealed that the yellowing of the coatings containing the blend of DETX with anthracene photosensitizer was less than that of the coatings containing DETX only. Depth-profile analyses of FTIR-ATR spectroscopy data showed that the dual curing significantly increased both surface and interior curing of the coating films. The RTIR and Photo-DSC analyses showed that the polymerization reactivity and the ultimate percentage conversion for the cationic clear and pigmented formulations containing photosensitizers were higher than the corresponding values for the formulation without photosensitizer.

Brown-Séquard Syndrome Caused by a Cervical Synovial Cyst

Synovial cysts are recognized as an uncommon cause of radicular and myelopathic symptoms. They are most frequently found in the lumbar region. The cervical spine or cervicothoracic junction is a rare location for a degenerative intraspinal synovial cyst as compared with the lumbar spine. At given cervical spinal levels, synovial cysts probably share clinical features with disc herniation and stenosis. However, the pathogenesis of synovial cysts remains still controversial. Here, we report a rare case of a synovial cyst in the lower cervical spine presented as Brown-Séquard syndrome and include a brief review of the literature. To the best of our knowledge, no previous report has been issued in the English literature on a synovial cyst presenting with Brown-Séquard syndrome. Neurologic function recovered completely after complete removal of the cyst and expansive laminoplasty.

Genetic analysis of ABCG2 and SLC2A9 gene polymorphisms in gouty arthritis in a Korean population

Background/Aims: Gout is a common inf lammatory arthritis triggered by the crystallization of uric acid in the joints. Serum uric acid levels are highly heritable, suggesting a strong genetic component. Independent studies to confirm the genetic associations with gout in various ethnic populations are warranted. We investigated the association of polymorphisms in the ABCG2 and SLC2A9 genes with gout in Korean patients and healthy individuals. Methods: We consecutively enrolled 109 patients with gout and 102 healthy controls. The diagnosis of gout was based on the preliminary criteria of the America College of Rheumatology. Genomic DNA was extracted from whole blood samples. We identified single nucleotide polymorphism (SNP) changes in the ABCG2 and SLC2A9 genes using a direct sequencing technique. rs2231142 in ABCG2 and rs6449213 and rs16890979 in SLC2A9 and nearby regions were amplified by polymerase chain reaction. Results: Patients with gout had significantly higher A/A genotype (29.3% vs. 4.9%, respectively) and A allele (52.8% vs. 26.5%, respectively) frequencies of rs2231142 in ABCG2 than did controls (χ2 = 29.42, p < 0.001; odds ratio, 3.32; 95% confidence interval, 2.11 to 5.20). We found novel polymorphisms (c.881A>G and c.1002+78G>A) in the SLC2A9 gene. The univariate logistic regression analysis revealed that the c.881A>G and c.1002+78G>A SNPs were significantly higher in patients than in controls. Conclusions: We demonstrated a significant association between rs2231142 in the ABCG2 gene and gout and identified novel SNPs, c.881A>G and c.1002+78G>A, in the SLC2A9 gene that may be associated with gout in a Korean population.

Clinical Analysis of Microscopic Removal of Discal Cyst

Objective The purpose of this study was to evaluate the clinical presentation and surgical outcome in patients with symptomatic discal cyst. Methods The authors reviewed consequent 9 patients in whom microscopic excision of the discal cyst with or without additional discectomy for discal cyst from 2005 to 2012. Diagnostic imagings including simple radiographs, computed tomography with discogram and magnetic resonance images were performed in each case. The patients were reviewed to evaluate the clinical presentation, surgical outcome and related complications. Results In all patients, discal cyst was located in the lumbar region and they presented with back pain and unilateral radiating pain. The preoperative magnetic resonance images (MRI) and computed tomography (CT) scan with discogram showed a connection between the cyst and the involved intervertebral disc. All patients obtained immediate relief of symptoms after microscopic excision of discal cyst. There were no recurrent lesions during follow-up period. The mean preoperative visual analogue scale (VAS) was 7.8 when compared with 2.6 in preoperative assessment. All patients obtained excellent or good outcome according to modified MacNabs criteria. Conclusion Discal cysts are rare lesions that can lead to back pain and refractory sciatica. Microscopic excision of the cyst can achieve remarkable improvement of symptoms.

Standardized, musculoskeletal ultrasonographic reference values for healthy Korean adults

Background/Aims To define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea. Methods A total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made. Results The 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the right-side second and third MCP joints were 0.55 and 0.55 mm, and those of the left-side joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology. Conclusions We defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.

AB0392 Safety and effectiveness of CT-P13 in patients with rheumatoid arthritis: results from 24 months nationwide registry in korea

Background CT-P13 is approved in both European Union and United States, and licensed for use in 79 countries around the world as a biosimilar to innovator infliximab (INX). The independent registries of CT-P13 have been conducted in a number of European countries and Korea [1]. Objectives To evaluate safety and effectiveness of CT-P13 when administered in a real-life setting in active RA patients. Methods This study collected data of patients who were treated with CT-P13 from 2013 December to 2016 June. Efficacy was assessed at baseline and every 6 months thereafter using DAS28 (ESR) and/or DAS28 (CRP) and collection of adverse events (AEs) was performed. Immunogenicity was assessed at baseline, Week 30 and every year during CT-P13 treatment period. Results Total 125 patients were enrolled; 104 patients started treatment with CT-P13 (Naïve group) and 21 patients (8 from INX, 13 from other anti-TNFs) switched treatment to CT-P13 (Switching group). The mean (SD) duration since RA diagnosis was 6.5 (±6.85) years for all patients. Of all patients treated with CT-P13, only 4.8% (6/125) of patients changed to other anti-TNFs. Two of six patients changed treatment within 8 month after starting CT-P13. The proportion of patients achieving clinical remission by DAS28 (ESR/CRP) increased gradually (Figure 1). DAS28 (ESR/CRP) value decreased from baseline at 6 months and it maintained thereafter (Table 1). Switching group also showed similar results that remission rate by DAS28 (CRP) was 42.9% (3/7) and mean actual value was 2.85 at 12 months. For Naïve group, 50% (52/104) of patients had at least one positive anti-drug antibody result and it is consistent to other published study [2]. Overall safety summarized as the percentage of patients with at least one treatment emergent AE (TEAE) was similar or lower after switching to CT-P13 (Table 2). No cases of active tuberculosis were reported.Table 1. DAS28 in CT-P13 Naïve group over 24 months Baseline 6 months 12 months 18 months 24 months DAS28 (ESR) n 67 62 40 14 3 Mean 5.78 3.61 3.30 3.01 2.42 SD 1.14 1.40 1.22 1.03 0.74 DAS28 (CRP) n 63 61 39 14 3 Mean 5.06 2.97 2.59 2.35 1.81 SD 1.19 1.21 1.06 0.69 0.63Table 2. Safety results in CT-P13 Naïve and Switching group Naïve group Switching group TEAEs 80.8% (84/104) 66.7% (14/21) Related TEAEs 31.7% (33/104) 28.6% (6/21) Infection and Infestation 42.3% (44/104) 33.3% (7/21) Conclusions The overall safety profile revealed that CT-P13 is well-tolerated in patients with RA and remission rate for 24 months also showed that CT-P13 is efficacious under real world practice. References Glintborg et al. ACR 2016. Krintel et al. Rheumatology 2013. Disclosure of Interest None declared

SAT0154 Effectiveness and safety of CT-P13 in patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and plaque psoriasis: observational study in republic of korea

Background CT-P13 is approved as a biosimilar of innovator infliximab for marketing in 79 countries around the world. After approval, observational study has been conducted in Republic of Korea in patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA) and Plaque Psoriasis (PS). Objectives To evaluate the effectiveness and safety of CT-P13 under routine care in Republic of Korea. Methods This observational study included both biologic naïve patients (Naïve group) and patients who switched from other anti-tumor necrosis factor (TNF)s to CT-P13 (Switch group). Effectiveness were evaluated based on remission (DAS28≤2.6 in RA, BASDAI<3 in AS and absence of swollen and tender joint counts in PsA), and response (BASDAI 20/50/70 in AS and PASI 50/75 in PS). Adverse events (AEs) were collected over 6 month period. Results Total 940 patients (400 with RA, 531 with AS, 3 with PsA and 6 with PS) were registered and 338 (36.0%) patients (108 with RA, 228 with AS, 2 with PS) who switched to CT-P13 were included. The proportion of patients achieving remission was similar between Naïve and Switch groups in both RA and AS during post-baseline visits (Table 1). In RA, the proportion of patients achieving each disease activity category by DAS28 was similar between Naïve and Switch groups (Figure 1). The proportion of patients who achieved BASDAI 20/50/70 response gradually increased from week 6 to week 24 or 30 in Naïve group with AS (Figure 1). Fifty percent of naïve patients with PsA achieved clinical remission. The proportions of both PASI 50 and 75 responses were 50% at Week 22 in Naïve group and were 100% and 50% in Switch group, respectively during post-baseline visits in PS patients. Throughout this study, treatment-emergent adverse events (TEAE) and treatment-emergent serious adverse events (TESAE) were reported as Table 2. Only 11% of patients experienced infection.Table 1. Clinical remission in RA and AS Naïve Switch Baseline Post-baseline Baseline Post-baseline RA DAS28 (ESR) 0/181 (0.0%) 24/182 (13.1%) 0/25 (0.0%) 5/25 (20.0%) DAS28 (CRP) 0/180 (0.0%) 43/179 (24.0%) 2/25 (8.0%) 6/24 (25.0%) AS BASDAI 2/292 (0.7%) 199/292 (68.2%) 112/209 (53.6%) 150/210 (71.4%)Table 2. Summary of safety results n/N (%) RA AS PsA PS TEAE 198/400 (49.5) 183/531 (34.5) 1/3 (33.3) 3/6 (50.0) TEAE related with CT-P13 73/400 (18.3) 64/531 (12.1) 0/3 (0.0) 2/6 (33.3) TESAE 52/400 (13.0) 14/531 (2.6) 0/3 (0.0) 1/6 (16.7) TESAE related with CT-P13 15/400 (3.8) 6/531 (1.1) 0/3 (0.0) 0/6 (0.0) Infusion-related reactions 28/400 (7.0) 11/531 (2.1) 0/3 (0.0) 0/6 (0.0) Conclusions CT-P13 is efficacious and well-tolerated in RA/AS/PsA/PS patients. Efficacy and safety results in patients treated with CT-P13 were clinically consistent to historical data [1,2,3]. Especially, Switch group results showed that CT-P13 provides a useful alternative to other anti-TNFs. References Kobayashi et al (2016). Hetland et al (2005). Hetland et al (2010). Disclosure of Interest D.-W. Kim: None declared, T.-H. Kim: None declared, S. R. Kwon: None declared, E. Y. Lee: None declared, C.-N. Son: None declared, Y. S. Kim: None declared, S. H. Kim: None declared, Y.-B. Park: None declared, J.-W. Hur: None declared, H.-S. Lee: None declared, S. J. Lee Employee of: CELLTRION,Inc., S. H. Lee Employee of: CELLTRION,Inc.

AB0400 Open Labeled, Multicenter 24-Week Study To Assess The Efficacy and Safety of Tacrobell® in Active Rheumatoid Arthritis Patients

Background Rheumatoid arthritis (RA) is chronic inflammatory disease characterized by persistent synovitis and structural joint damage with T cell-driven inflammation. Tacrolimus suppress activation of T cells through the inhibition of calcineurin. Objectives We evaluated the efficacy and safety of Tacrobell® (Tacrolimus from Chong Kun Dang Pharma Inc.) in Korean active RA patient who had inadequate response to disease-modifying anti-rheumatic drugs (DMARDs) including Methotrexate (MTX). Methods During the study period from Aug. 2012 to Jun. 2015, in this open labeled, multicenter study, 111 patients were enrolled. Patients were in active disease state with Disease Activity Score28 (DAS28) ≥3.2 despite previously taken at least one conventional DMARD including MTX. Patients had wash out period with DMARDs, except MTX. Patients received Tacrobell® during 24 weeks. The initial dose was 1 mg once daily and was increased to 3mg once daily by 1mg, every 4 weeks. The disease activity was measured by the DAS28-ESR at 4, 8, 16, 24-week after the add on Tacrobell®. Simplified Disease Activity Index (SDAI), Korean Health Assessment Questionnaire (KHAQ)-20, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and the safety was assessed. Results Data from 97 patients were evaluated in full set analysis. At week-24, EULAR response rate were 83.5% (81 of 97) with improvements from week-16 in 74.2% (72 of 97). Mean DAS28-ESR was continuously decreased of 5.64 at baseline, 4.14 (±1.22, p<0.001) at week-16 and 3.66 (±1.39, p<0.001) at week-24. Efficacy rates according to SDAI were 89.7% (87 of 97) and KHAQ-20 score decreased -2.42 (±4.37, p<0.001) from baseline 7.27 (±4.59) at week-24. Mean ESR was decreased -10.97 (±24.16, p<0.001) at week-16, -14.77 (±24.57, p<0.001) at week-24 from baseline 46.05 (±23.22). Mean CRP was decreased from 2.86 (±7.85, p=0.0578) at baseline to 1.34 (±3.02, p=0.0367) at week-24. The most common adverse events were in gastrointestinal (18 of 108; 16.679%) and respiratory disorder (12 of 108; 16.67%). In serious adverse events (6 of 108, 5.56%), two cases (pneumonia, high glucose level) were related with Tacrobell® and recovered with treatment. At laboratory exam, no abnormal findings with increased BUN or Cr as known common Tacrolimus side effect. Systolic blood pressure increased 2.12 mmHg at week-8. Conclusions This study demonstrated the efficacy of add on Tacrobell® therapy to MTX in patients with active RA. References Tsutomu T., et al (2013) Post-marketing surveillance of the safety and effectiveness of tacrolimus in 3,267 Japanese patients with rheumatoid arthritis Mod Rheumatol.; 24(1):8–16 Takeyuki K., et al (2013) Long-term therapeutic effects and safety of tacrolimus added to methotrexate in patients with rheumatoid arthritis Rheumatol Int.; 33:871–877 Mariko K., et al (2013) Efficacy of adjunct tacrolimus treatment in patients with rheumatoid arthritis with inadequate responses to methotrexate Mod Rheumatol.; 23:788–793 Kawai S., et al. (2011) Efficacy and safety of additional use of tacrolimus in patients with early rheumatoid arthritis with inadequate response to DMARDs-a multicenter, double-blind, parallel-group trial Mod Rheumatol.; 21(5):458–68 Disclosure of Interest None declared

AB0093 Regulation of Autophagic Flux Alters Interleukin-17A-Induced Migration and Proliferation of Fibroblast-like Synoviocytes from The Patients with Rheumatoid Arthritis

Background Interleukin-17A (IL-17A) plays a critical role in the pathogenesis of rheumatoid arthritis (RA), which is characterized by exaggerated synovial proliferation. Autophagy is required to prevent accumulation of cellular damage and to ensure cellular homeostasis. Dysregulated autophagy has been reported to be involved in the pathogenesis of several diseases such as cancer and infections. Here, we hypothesized that IL-17A, a key cytokine in the development of RA, might have an impact on autophagic flux and that aberrant autophagy might be involved in expansion of synovial fibroblasts in the patients with RA, which is stimulated by pro-inflammatory cytokines. Objectives The aims of this study were (1) to evaluate whether IL-17A influences on autophagic flux in the synovium of the patients with RA and (2) to investigate whether the modulation of autophagy can regulate migration and proliferation of fibroblast-like synoviocytes (FLS) from the patients with RA (RA-FLS) under inflammatory milieu. Methods Synovial tissue was obtained from the patients with RA or osteoarthritis (OA) during total knee replacement surgery. FLS was cultured with IL-17A, autophagy inducer or inhibitor. The expression of marker proteins for autophagic flux (LC3B, Beclin1, Atg5, p62) and the formation of autophagolysosome (LAMP1) were analyzed by western blot. A migration scratch assay was used to assess FLS migration in response to stimulation with IL-17A. Proliferation of FLS was determined by the viable cell count using trypan blue. Bafilomycin was used for inhibiting autophagic flux. Results The expression of autophagy markers (LC3B, Beclin1, Atg5) was increased in the synovium of the patients with RA than in that of the patients with OA. Autophagy was also enhanced in RA-FLS compared with OA-FLS. IL-17A upregulated the expression of LC3B, Atg5, Beclin1, LAMP1 in RA-FLS. In particular, IL-17A-induced accumulation of p62 was prominent in RA-FLS. Migration and proliferation of FLS stimulated by IL-17A was suppressed by the inhibition of autophagy. Conclusions This study reveals that IL-17A stimulates autophagic flux and that intervention of autophagy can control IL-17A-induced migration and proliferation of FLS. Our results also provide additional evidence for a significant role of autophagy in the pathogenesis of RA. Thus, we suggest that autophagy might be a potential therapeutic target for the management of RA. References Lin NY, Beyer C, Giessl A, et al. Autophagy regulates TNFα-mediated joint destruction in experimental arthritis. Ann Rheum Dis. 2013 May;72(5):761–8. Connor AM, Mahomed N, Gandhi R, et al. TNFα modulates protein degradation pathways in rheumatoid arthritis synovial fibroblasts. Arthritis Res Ther. 2012 Mar 14;14(2):R62. Disclosure of Interest None declared

AB0577 Sleep Quality in Behcet's Disease Is Associated with Disease Activity, Depression, and Quality of Life in Korean Populations

Background Behcets disease is a chronic, systemic vasculitis that can involve all sizes of blood vessels. Those complicated symptoms lead to the patients impairment of life quality as well as psychological problems. Sleep disturbance is one of the most particular concerns in patients with Behcets disease. It has been known that the disease activity of rheumatoid arthritis and ankylosing spondylosis is associated with the sleep quality. However, studies about the sleep quality of patients with Behcets disease in Korean population are limited. Objectives The purpose of this study was to find out the effects of sleep quality on Behcets disease in Korean population. We also investigated the relationship between depression, quality of life, other clinical findings of Behcets. Methods The study was performed by cross-sectional design in two tertiary hospitals. We met one hundred patients with Behcets disease, surveyed them face-to-face and conducted the chart review for more clinical informations. Sleep quality was assessed by the Korean version of Pittsburgh sleep quality index (PSQI). Disease activity of Behcets disease was evaluated by Behcets disease current activity form (BDCAF). Depression was assessed by the Korean version of Beck depression inventory second edition (BDI-2). Quality of life was assessed by the Korean version of the Leeds Behcets Disease Quality of Life Measure (BDQoL). Results Among 100 patients, median age was 51 [44.5–56.0] years, median disease duration was 77.5 [24.0–136.0] months and 31% were male. Those who met the diagnostic critera of fibromyalgia were 28 patients. The frequency of poor sleep quality (PSQI >5) was 67%. Patients with poor sleep quality tend to have higher BDI2, BDCAF and pain VAS score (P<0.001, P=0.028, and P=0.011). Female rate was significantly higher, and BDQoL was lower in poor sleeper group (P=0.004 and P<0.001). Among 7 PSQI components, daytime dysfunction was higher in patients with high disease activity (P=0.03). Total PSQI score were strongly correlated with BDCAF score, BDI-2 score, BDQoL score, and pain VAS score (P=0.02, P<0.001, P<0.001, and P<0.001, respectively). Conclusions The low quality of sleep is associated with disease activity, depression and quality of life in Korean patients with Behcets disease. We expect better disease control will improve the sleep quality. References Tascilar NF, Tekin NS, Ankarali H, Sezer T, Atik L, Emre U, Duysak S, Cinar F. J Sleep Res 2012;21:281–8. Melikoglu MA, Melikoglu M. Rheumatol Int 2010;30:941–6. Disclosure of Interest None declared