P. Zarco

First signs and symptoms of spondyloarthritis—data from an inception cohort with a disease course of two years or less (REGISPONSER-Early)

Objective. To determine the first signs and symptoms, and the clinical, biological and radiological characteristics of patients with early SpA. Methods. A total of 150 SpA patients were selected from 2367 listed in REGISPONSER (Registro Español de Espondiloartritis de la Sociedad Española de Reumatología). The inclusion criterion was a disease course of ⩽2 yrs from the onset of symptoms or the appearance of the first sign of disease. Results. Forty-six patients had AS, 51 psoriatic SpA (Ps-SpA), 43 uSpA, 5 ReA, 4 IBD arthropathy and 1 JCA. The mean age at onset of symptoms and at diagnosis was higher in Ps-SpA group (48.1 ± 13.6 and 48.5 ± 13.6 yrs) than in AS group (38.1 ± 12.8 and 38.9 ± 12.7 yrs) and uSpA group (36.3 ± 11.5 and 36.9 ± 11.4 yrs). The most frequent signs or symptoms were back pain: 72% AS group and 56% uSpA group. Lower limb arthritis was the first symptom in 57% Ps-SpA patients, 35% uSpA patients and 20% AS patients; upper limb arthritis was the first symptom in 53% Ps-SpA group and <16% of the remainder. Compared with longer duration disease, at onset, AS patients report upper limb arthritis more frequently and uSpA patients report more of enthesitis. Early radiological sacroiliitis was observed in all AS patients, of whom 54% had Grade II, 39% had Grade III and 7% had Grade IV. Conclusions. In our population, the first manifestations of SpA were low back pain and SI syndrome in AS and uSpA patients and peripheral arthritis in the Ps-SpA group. We can find early SI joint affectation in AS patients.

Validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme

Objectives To evaluate the validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in early spondyloarthritis (SpA) in comparison with conventional clinical measures of disease activity. Methods Six hundred and seventy-six incident cases of early SpA from the Esperanza programme were included. Patients were categorised into high and low disease activity states based on patient and physician global assessment scores and on the physicians decision to start treatment with a disease-modifying antirheumatic drug or tumour necrosis factor blocker. The discriminant ability of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) was tested using standardised mean differences between patients with high and low disease activity. Convergent validity was tested by Pearson correlation between ASDAS versions and other measures of disease activity. Results ASDAS-ESR and ASDAS-CRP showed good correlation with BASDAI (r=0.79 and 0.74, respectively). Both indices correlated well with the patient global assessment (r=0.70 in both indices) and moderately with the physician global score (r=0.46 and 0.47, respectively). CRP and ESR showed poor correlation with patient- and physician-derived measures. ASDAS performed similarly across the global SpA sample, ankylosing spondylitis (AS), non-radiographic axial SpA and peripheral SpA. Conclusions ASDAS performed as a valid activity score even being slightly better than the Bath Ankylosing Spondylitis Disease Activity Index in its ability to discriminate between high and low disease activity in early SpA. ASDAS performed similarly in AS, early forms of SpA, non-radiographic axial SpA and peripheral SpA.

Usefulness of a centralized system of data collection for the development of an international multicentre registry of spondyloarthritis

Objective. To present the usefulness of a centralized system of data collection for the development of an international multicentre registry of SpA. Method. The originality of this registry consists in the creation of a virtual network of researchers in a computerized Internet database. From its conception, the registry was meant to be a dynamic acquiring system. Results. REGISPONSER has two developing phases (Conception and Universalization) and gathers several evolving secondary projects (REGISPONSER-EARLY, REGISPONSER-AS, ESPERANZA and RESPONDIA). Each sub-project answered the necessity of having more specific and complete data of the patients even from the onset of the disease so, in the end, obtaining a well-defined picture of SpAs spectrum in the Spanish population. Conclusion. REGISPONSER is the first dynamic SpA database composed of cohorts with a significant number of patients distributed by specific diagnosis, which provides basic specific information of the sub-cohorts useful for patients’ evaluation in rheumatology ambulatory consulting.

AB0707 Checklists (Minimun and Excellence) for The Evaluation of Patients with Axial Spondiyoarthritis in Daily Practice: Personaliza Project

Background Currently there is great workload in rheumatologic clinics and a lot of variability in the type and number of potential measures for patients with axial SpA. Objectives To standardize axial SpA evaluation in daily practice through the generation of two checklists (one for minimum and another of excellence). Methods A qualitative study was performed. First, an expert panel was set up (8 rheumatologists with interest and experience in axial SpA). A focal group with patients was organized. Barriers and facilitators in the evaluation and management of patients with axial SpA was analyzed. A systematic literature review was performed in order to identify measures for axial SpA and methodological characteristics as their validity or impact in daily practice. All of this information was presented to the experts and discussed. As a result, a draft of variables for a proper evaluation of patients with axial SpA was proposed. Then, the experts evaluated different characteristics of these variables (validity, feasibility, impact, etc) and selected a feasible and relevant list of variables (minimum checklist, in case of busy clinics or less skilled professionals) and added some other interesting variables (excellence checklist, the ideal evaluation) to cover all the domains of the disease. With these variables an electronic and paper checklists were designed. Results Two checklists were generated. The minimum checklist includes a) Personal history (date of symptoms start, date of diagnosis, family history of Crohn disease/ulcerative colitis, psoriasis, reactive arthritis, uveitis, spondyloarthritis, smoking status, peripheral disease, enthesitis, dactylitis, extra-articular manifestations, profession, physical activity, inflammatory low back pain; b) Comorbidity (arterial hypertension, Diabetes Mellitus, hypercholesterolemia, cardiovascular disease, gastric ulcers, depression, osteoporosis, others); c) Physical examination (enthesis, synovitis, hips, dactylitis, modified Schöber, thoracic expansion, cervical rotation); d) Activity control (ASDAS, BASDAI, physician VAS, d) Function: BASFI; e) Labs and imaging (hemogram, ESR, biochemistry, CRP, urine, axial and sacroiliac x-ray, HLA B-27); f) Treatments (NSAID, biologic therapy, cessations and reasons, other treatments, physical activity). In the excellence checklist along with the previous, the following variables were included: blood pressure, cardiac frequency, weight, height, BMI, abdominal perimeter, BASMI, lipids, 25-OH Vitamin-D, glicohaemoglobina, microalbuminuria, DEXA. Conclusions These checklists for patients with axial SpA might help evaluate rheumatologists in daily practice in order to early recognition and management of comorbidities, disease activity and other outcomes. References http://www.ser.es/wp-content/uploads/2015/09/EMAR_Informe.pdf/p> Disclosure of Interest None declared

FRI0292 Correlation biomarkers of cartilage and bone turnover with disease activity, ASDAS, function, quality of life, radiology and magnetic resonance imaging in patients with early spondiloarthritis

Objectives To determine the relationship between biomarkers and activity, functional capacity, quality of life and radiology in early SpA.To analyse the influence of sex, HLA B27, psoriasis, osteitis in MRI and involvement pattern on biomarkers[matrix metalloproteinase-3 (MMP-3), high sensitivity C-reactive protein (hsCRP), C Telopéptide (CTX) and D-Pyridoline] in early spondiloarthritis (SpA). Methods A cross-sectional study of baseline visits from 60 patients included in Esperanza program was performed. Patients analyzed were under 45 years old, with onset symptoms within the range of 3 to 24 months.All patients included met the following criteria: a) inflammatory back pain, or b) symmetric arthritis, or c) back pain/articular pain, in addition to at least one of the following: a) psoriasis, b) inflammatory bowel disease, c) anterior uveitis, d) radiographic sacroiliitis, e) family history ofspondylitis, psoriasis, IBD, or AU, f) HLA-B27 positive. Data collected: social/demographic, ESR, CRP, HLA-B27, BASDAI, ASDAS, BASFI, total BASRI and ASQol.MRI of sacroiliac joints (SIJs) was performed on 32 patients and activity was defined according to the ASAS Group definitions for active lesions on MRI. Serum MMP-3 (ELISA), CTX (Cromatogrphic), hsCRP (Nefelometric) and urinary D-pyridoline (QLIA) were measured in all patients. Analysis: Chi square was used to compare rates and U de Mann-Whitney to analyze continuous variables.Pearson correlation coefficient analysis was performed to examine the contribution of differents biomarkers. Results At baseline, atotal of 60 patients diagnosed of early SpA were included: 26 male (43.3%) and 34 female (56.7%),with age 32.4±6.7 years and disease duracion of 12.4±6.8 months. Twenty two percent of patients had tenían axial affectation, 63.6% peripheral, 4.5% mixed and 9% enthesitic pattern. HLA B27 was positive in 32.6% patients.Twenty two patients (68.7%) had active sacroiliitis by MRI. The values (mean ±SD) were: nocturnal pain (cm) 4.5±2.6; BASDAI (cm) 4.3±2.4; ASDAS 2.2±1.1; ESR (ml/h)14.7±14.6; CRP (mg/L) 5.3±9.4; BASFI (cm) 2.7±2.4; total BASRI 0.68±1.2 and ASQol 6.7±5. CTX (0.53 μgr/L vs. 0.24μgr/L; p=0.001) and MMP-3 (44.3 μgr/L vs. 24.7 μgr/L; p=0.001)were significantly higher in male than in female. CTX (r=0.4, p=0.01)and MMP-3 (r=0.5, p=0.01)showed correlation with arthritis.hsCRPshowed a significant correlation with the ESR level (r=0.3, p=0.04). MMP-3 and urinary D-pyridoline demonstrated a trend toward a positive correlation with ESR (r=0.3, p=0.08) and (r=0.2, p=0.08), respectively. hsCRP showed a trend toward a positive correlation with total BASRI (r=0.4, p=0.05) Conclusions In our study, the male sex is associated with higher levels of CTX and MMP-3 in early SpA, which may indicate higher radiographic damage in men. Previous papers found correlation between C Telopéptide and MMP-3 with radiographic damage (1,2). We found significant correlation between CTX and MMP-3 witn arthritis, as a biomarkers reflecting disease activity. References Maksymowych WP.Arthritis Rheum 2007, 56:1846-53. Vosse D. Rheumatology 2008, 47:1219-22. Disclosure of Interest R. Almodovar Grant/Research support from: “Esperanza Program has been supported by an unrestricted grant from Pfizer”, V. Rios: None Declared, S. Ocaña: None Declared, M. L. Casas: None Declared, M. Gobbo: None Declared, P. Zarco: None Declared, X. Juanola: None Declared, R. Mazzucchelli: None Declared, J. Quiros: None Declared

AB0555 Are there differences in biomarkers of cartilage and bone turnover between patients with familial versus sporadic early spondiloarthritis

Objectives Our purpose was analyze potential differences in biomarkers of cartilage and bone turnover between patients with familial early spondyloarthritis (SpA) and sporadic early EspA. Methods A cross-sectional study of baseline visits from 60 patients included in Esperanza program was performed. Patients analyzed were under 45 years old, with onset symptoms within the range of 3 to 24 months. All patients included met the following criteria: a) inflammatory back pain, or b) symmetric arthritis, or c) back pain /articular pain, in addition to at least one of the following: a) psoriasis, b) inflammatory bowel disease (IBD), c) anterior uveitis (AU), d) radiographic sacroiliitis, e) family history of spondylitis, psoriasis, IBD, or AU, f) HLA-B27 positive. Data collected: social/demographic, ESR, CRP, HLA-B27, BASDAI, ASDAS, BASFI, total BASRI and ASQol. MRI of sacroiliac joints (SIJs) was performed on 32 patients and activity was defined according to the ASAS Group definitions for active lesions on MRI. Serum MMP-3 (ELISA), CTX (Cromatogrphic), hsCRP (Nefelometric) and urinary D-pyridoline (QLIA) were measured in all patients. Familial early spondyloarthritis (EspA) was considered when the patient confirmed having first-degree relatives with diagnostic of spondiloarthropathy, defined by ESSG criteria. Analysis: Chi square was used to compare rates and U de Mann-Whitney to analyze continuous variables. Results At baseline, a total of 60 patients diagnosed of early SpA were included: 26 male (43.3%) and 34 female (56.7%), with age 32.4± 6.7 years and disease duracion of 12.4± 6.8 months. Twenty two percent of patients had axial affectation, 63.6% peripheral, 4.5% mixed and 9% enthesitic pattern. HLA B27 was positive in 26.6% patients. Thirteen percent had psoriasis. Twenty one patients (35%) had active sacroiliitis by MRI. The values (mean ± SD) were: nocturnal pain (cm) 4.5± 2.6; BASDAI (cm) 4.3 ± 2.4; ASDAS 2.2 ± 1.1; ESR (ml/h)14.7± 14.6; CRP (mg/L) 5.3± 9.4 ; BASFI (cm) 2.7± 2.4; total BASRI 0.68 ±1.2 and ASQol 6.7± 5. The frecuency of familial early SpA was of the 8.3% (n=5). The values of biomarkers between sporadic vs familial early SpA (mean ± SD) were: MMP-3 (36,2± 47.2 vs 15.8± 8.7 p= 0.09); CTX : (0.38± 0.31 vs 0.26± 0.14, p= 0.28); D- pyridoline: (12.7± 7.7 vs 11.2± 3.8, p= 0.98); hs PCR: (0.6± 0.5 vs 1± 4.8 p= 0.9). Conclusions In our study, MMP-3 showed upward trend to higher levels in patients with sporadic early SpA. Which may indicate higher radiographic damage in these patients. Previous papers found correlation MMP-3 with radiographic damage (1). In the rest of biomarkers we didn’t objetive differences between patients with sporadic versus familial early spondiloarthritis. “Esperanza Program has been supported by an unrestricted grant from Pfizer” References Maksymowych WP, Landewé R, Conner-Spady B, et al. Serum matrix metalloproteinase 3 is an independent predictor of structural damage progression in patients with ankylosing spondylitis. Arthritis Rheum 2007, 56:1846-53. Disclosure of Interest None Declared

FRI0417 Long term influence of nsaids on radiographic progression in patients with ankylosing spondylitis.

Background The inhibitory effect of the treatment on styructural damage in AS is not completely understood and it is sill a matter under debate. Recent data indicated that NSAIDs could retard radiographic progression in certain subgroups of patients[1],[2] Objectives To investigate the long term influence of NSAIDs on the rate of radiographic progression administrated as continuous vs.on-demand therapy. Methods Patients included in REGISPONSER with the diagnosis of AS were selected and ought to be administrated only NSAIDs for a period of 3 years. Patients were divided in 2 groups according to NSAIDs intake (continuously vs on-demand). BASRI-spine was applied at baseline and after 3 years. Patients who had the maximum BASRI value of 12 at baseline were excluded form the study. X2 test, student T test and ANCOVA were applied to compare differences between groups. A logistic regression was performed to analyze the influence of NSAIDs treatment and other factors on the rate of radiographic progression. Results One hundred eighteen patients were included. No significant differences were found in the two treatment groups at baseline, with exception of disease activity(table 1). Significant radiographic progression was identified in the 2 treatment groups after 3 years follow up( p<0.001). The mean BASRI change was 0.66 ± 1.04 in on-demand treatment group vs.0.64 ± 1.22 in continuous treatment group (p-NS after adjustment for symptoms duration). Although in the logistic regression the type of NSAID treatment was not identified as independent predictive factor of increased radiographic damage as were male sex (p= 0.025) and baseline damage (p<0.001), a significant interaction was found between NSAIDs treatment and time-average (ta) CRP (>6 vs. ≤6 mg/L) (OR: 0.04, CI95 %( 0.003-0.524) Conclusions NSAIDs treatment could not stop radiographic damage in AS. Patients with high CRP level who received NSAIDs on–demand showed the highest progression risk. References Poddubnyy D, Rudwaleit M, Haibel H, Listing J, Märker-Hermann E, Zeidler H, et al. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort. Ann Rheum Dis. 2012, 71:1616-22. Kroon F, Landewé R, Dougados M, van der Heijde D. Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis. Ann Rheum Dis. 2012;71:1623-9. Disclosure of Interest None Declared

FRI0556 Development of standards of care in spondyloarthritis

Background Currently, the use of standards of care (SoC) could be the first step to achieve optimal care in patients with spondyloarthritis (SpA). Objectives The aim of this project (2e) was to develop evidence-based and user-focused SoC for SpA. Methods A RAND-modified Delphi method was applied. First, a systematic literature review of national and international documents covering SOC for SpA was conducted. This included consensus, clinical guidelines and care management documents. Social leagues and health professionals were contacted. All the information retrieved was evaluated by two expert methodologists and, subsequently, adapted and classified according to the three categories of SOC: structure, process and outcomes. A group of 23 experts on SpA was selected and a consensus meeting was held where these SOC were discussed. Afterwards, a first questionnaire round was sent to the experts panel and the SOC were modified according to the results of this round. Finally, a second questionnaire round with the final set of SOC was sent to 167 rheumatologists all around Spain to assess their agreement grade about every SoC. Results A total of 38 SoC were set (12 for structure, 20 for process and 6 for outcomes). A selection with the SoC that got highest priority is shown in the table. In general, standards of process achieved high priority whereas standards of result got the lowest grade of agreement. Image/graph Conclusions The implementation in clinical practice of this set of SoC could help assess and improve the quality of care for patients with SpA. Disclosure of Interest None Declared

Right Hip Pain in a 65-Year-Old Woman

In order to reach the definite diagnosis, homogentisic acid was determined in a 24-hour sample of the patients’ urine through photometry, showing a value of 1175 mg/L (0-0 mg/L) and confirming the diagnosis of ochronosis. It was noticed that urine turned dark upon exposure to sunlight (Figure 4). The study was completed with an echocardiogram in which an aortic valve sclerosis was seen, a densitometry with a lumbar spine T score of –3.24 standard deviations (SD) and of –1.51 SD on the femoral neck, bilateral hypoacusia was also evidence upon hearing examination. A total hip arthroplasty was performed on the right hip and a left hip prosthesis was placed after 8 months due to rapidly progressive joint destruction.