Roksanda Stojanovic

The prognostic value of nailfold capillary changes for the development of connective tissue disease in children and adolescents with primary raynaud phenomenon: a follow-up study of 250 patients.

Abstract:  To assess the prognostic value of capillaroscopy findings for the development of connective tissue disease in children and adolescents with Raynaud phenomenon, we followed up a group of 250 (mean age 15 years) for 1 to 6 years after the first capillaroscopy was performed. Every 6 months they were screened for signs and symptoms of connective tissue disease. Analysis was performed on capillary changes registered 6 months before the development of connective tissue disease. Capillary changes were classified into three types: normal, nonspecific, and sclerodermatous. At the end of the follow‐up period, 191 (76%) subjects had primary Raynaud phenomenon, 27 (10.8%) were diagnosed as having undifferentiated connective tissue disease, and 32 (12.8%) fulfilled the criteria for a diagnosis of a specific connective tissue disease. Systemic lupus erythematosus was found in nine (3.6%) patients, rheumatoid arthritis in 10 (4%) patients (six of them with juvenile onset rheumatoid arthritis), and scleroderma spectrum disorders in 13 (5.2%). The mean time for the evolution of Raynaud phenomenon into undifferentiated connective tissue disease or a form of the disease was 2 years. Most of the subjects with primary Raynaud phenomenon (173/191, 91%), undifferentiated connective tissue disease (22/27, 81%), juvenile onset rheumatoid arthritis/rheumatoid arthritis (7/10, 70%), and systemic lupus erythematosus (6/9, 67%) had normal capillary findings. Nonspecific capillary changes occurred in 3 of 10 (30%) patients with rheumatoid arthritis, 2 of 9 (22%) with systemic lupus erythematosus, 4 of 27 (15%) with undifferentiated connective tissue disease, and 18 of 191 (9%) with primary Raynaud phenomenon. Of all the subjects, only 10 (4%) showed sclerodermatous disease type capillary changes 6 months before the expression of a particular disease: eight (62%) of these developed scleroderma spectrum disorders, one expressed systemic lupus erythematosus, and one had undifferentiated connective tissue disease. We concluded that there were no specific capillary changes predictive for future development of systemic lupus erythematosus, juvenile onset rheumatoid arthritis/rheumatoid arthritis, and undifferentiated connective tissue disease in children and adolescents with Raynaud phenomenon. Most of our study subjects with Raynaud phenomenon who developed these diseases had normal capillary findings or nonspecific changes. Children and adolescents who developed scleroderma spectrum disorders showed a sclerodermatous type of capillary changes 6 months before the expression of the disease, indicating that this type of capillary changes in children and adolescents with Raynaud phenomenon highly correlated with further development of scleroderma spectrum disorders.

Bone mineral density in children with juvenile idiopathic arthritis after one year of treatment with etanercept

Introduction/Objective Juvenile idiopathic arthritis (JIA) is the most frequent chronic inflammatory, rheumatic disease of childhood, associated with disturbance of bone mineral metabolism, which develops gradually and progressively, and if untreated eventually leads to osteoporosis in adulthood. The aim of our study was to evaluate bone mineral density (BMD) in patients with JIA treated with etanercept over a period of one year. Methods The prospective cohort study included 94 JIA patients (66 female, 28 male), their median age being 14.77 years. BMD was measured by dual-energy X-ray absorptiometry on the lumbar spine. Disease activity was assessed using the American College of Rheumatology Pedi 50 criteria. Results After one year of treatment with etanercept, we found a statistically significant increment in all osteodensitometry variables (p < 0.001). Annual enhancement for the whole group was as follows: bone mineral content 15.8%, BMD 7.2%, BMDvol 4.2%. Z-score improved from -0.86 to -0.58 SD at the last visit, but decreased in rheumatoid factor-positive polyarthritis patients. Patients with systemic JIA had the lowest Z-score. Z-score correlated with functional disability level. BMD was lower in the group treated with glucocorticoids. Conclusion Our results showed significant improvement of bone mineral density in children with JIA after one year of treatment with etanercept. Rheumatoid factor-positive and systemic JIA subtypes and treatment with glucocorticoids are the risk factors for impairing bone mineral metabolism.

AB1149 The ability of the health system to identify the burden of rheumatoid arthritis in serbia: a eular survey

Objectives to estimate the rheumatoid arthritis (RA) prevalence in two urban regions of Serbia, covering the northern and the southern part, under the European League Against Rheumatism (EULAR) prevalence survey; to assess the ability of the health system to recognize and treat patients with RA. Methods The survey was conducted in four Serbian towns: Belgrade in the north and three towns in the south: Cacak (Moravicki region), Uzice (Zlatiborski region) and Krusevac (Rasinski region), covering 36.5% of the total Serbian population with more than 99% Caucasians, mostly orthodox Serbs (83%), <4% Hungarians, Roms and Bosnians and a minority of other nationalities. The first-detection phase of the study comprised previously translated and validated telephone Questionnaire usage with 33 items covering signs, symptoms, self-reported diagnosis and classification criteria for RA (ACR 1987) (1). Diagnoses were confirmed by rheumatologists in a second-confirmation phase. Prevalence results were standardized for age and sex with regard to Serbian population (national census 2002). Confirmed RA cases were asked two more questions: “How long had you had symptoms before you were given the diagnosis of RA” and “How had you been treated for that period of time”. Results 6213 people were contacted and 63.6% answered the survey; joint pain was reported by 1,799 persons, and joint pain accompanied with joint swelling by 606 persons. A total of 23 RA cases were identified; 2 newly diagnosed. The standardized RA prevalence estimates were 0.30% (95% confidence interval [95% CI] 0.09;0.51) for the north, e.g. 0.09 (95% CI 0.08;0.26) for men and 0.49% (95% CI 0.19;0.79) for women. RA prevalence estimates were 0.42% (0.12;0.72) for the south; 0.28 (0.00;0.56) for men and 0.55% (0.09;1.00) for women, with the female to male ratio 5,5:1 in the north and 2:1 in the south. Time period from the first symptoms occurence to the RA diagnosis was 17.7 (13.2) months for the northern part and 25.0 (16.9) for the southern; 20.6 (14.9) for Serbia; in that period patients were mostly treated with NSAIDS (82%) and physical therapy (30%); short-lasting corticosteroids were given to 13%, peroral corticosteroids to 4% and no patients were treated with DMARDS. Conclusions RA prevalence in the southern and northern part of Serbia is in line (0.42% [95% CI 0.12;0.72]) vs 0.30% [95% CI 0.09;0.51]), being more frequently presented in females as compared to males (five times more in the north and two times more in the south). Delay in diagnosis as compared to the first symptoms occurence was 21 months and during that time no patients were treated with DMARDS. References Zlatkovic-Svenda MI, Stojanovic RM, Milenkovic MP, Vlajinac HD, Le Bihan E, Guillemin F. Adaptation and validation of a telephone questionnaire – Serbian version for case detection of rheumatoid arthritis and spondyloarthropathy (multicentric Eular study). Clin Exp Rheumatol. 2007;25 (1): 75–84. Disclosure of Interest None declared

SAT0595 Spondyloarthritis Prevalence in Europe, A EULAR-Endorsed Survey

Background The spondyloarthritis (SpA) prevalence has shown a trend to increase in the last two decades, in line with better recognition of the disease as well as the use of new classification criteria (1). The need to estimate and compare the SpA prevalence accross Europe was recognized. Objectives to estimate the SpA prevalence in several European countries: France, Turkey, Lithuania and Serbia using identical methodology and sampling; to standardize the results with reference to the European Standard Population by using direct method. Methods A two-step approach was taken. First, a unique detection Questionnaire, covering self-reported diagnosis, SpA classification criteria (ESSG 1991), personal and family history for SpA (2), previously translated and validated for each of the participating countries, was administered to a population sample. A two-stage sampling was carried out on seven areas covering 20 counties in France, seven geographical regions covering 25 administrative provinces in Turkey, two largest cities- Vilnius and Kaunas in Lithuania and two geographical regions covering four counties in Serbia. Second, diagnoses were confirmed by rheumatologists. Results were standardized by age and sex using the European Standard Population, defined as EU-27+EFTA, 2010 estimates. Results Detection Questionnaire was administered by telephone on 15219 persons in France (3), 6558 in Lithuania (4) and 6213 in Serbia (1), with 64.7%, 64.7% and 63.3% response rate, respectively. In Turkey, Questionnaire was administered face-to face on 4012 persons. Diagnoses were confirmed for 29 cases in France (37.9% male), 18 in Turkey (16.7% male), 27 in Lithuania (55.6% male) and 16 in Serbia (37.5% male). Estimates of the SpA prevalence standardized for age and sex are given in Table 1.Table 1. Age- and sex- standardized SpA prevalence, % (95% CI) for France, Lithuania, Turkey and Serbia, ≥18 years Men Women Total France 0.29 (0.12–0.47) 0.31 (0.16–0.45) 0.30 (0.19–0.41) Lithuania 1.38 (0.68–2.09) 0.39 (0.16–0.63) 0.89 (0.78–1.00) Turkey 0.17 (0.00–0.36) 0.57 (0.28–0.87) 0.37 (0.18–0.56) Serbia 0.38 (0.06–0.71) 0.32 (0.10–0.54) 0.35 (0.17–0.54) Conclusions Age- and sex-standardized SpA prevalence estimates in France, Turkey and Serbia were in line, but were as twice as high in Lithuania, confirming a north-south decreasing gradient using homogenous sampling and case ascertainment method. Standardized SpA prevalence estimates in men and women were similar in France and Serbia, but not in Turkey and Lithuania. This study adds to previous observation on similarity of RA and SpA prevalence estimates. References Zlatković-Švenda M, Stojanović R, Šipetić-Grujičić S, et al. Prevalence of spondyloarthritis in Serbia: a EULAR endorsed study. Ann Rheum Dis. 2015; 74(10):1940–2. Guillemin F, Saraux A, Fardellone P, et al. Detection of cases of inflammatory rheumatic disorders: performance of a telephone questionnaire designed for use by patient interviewers. Ann Rheum Dis 2003;62:957–63. Saraux A, Guillemin F, Guggenbuhl P, et al. Prevalence of spondyloarthropathies in France: 2001. Ann Rheum Dis 2005;64:1431–5 Adomaviciute D, Pileckyte M, Baranauskaite A et al. Prevalence survey of rheumatoid arthritis and spondyloarthropathy in Lithuania. Scand J Rheumatol 2008;37:113–9. Acknowledgement Study supported by a EULAR grant Disclosure of Interest None declared

THU0358 The Ability of the Health System to Identify the Burden of Spondyloarthritis in Two Regions of Serbia: A Eular Survey

Objectives To determine spondyloarthritis (SpA) prevalence in two different regions of Serbia, as part of the European League Against Rheumatism (EULAR) prevalence survey; to assess the ability of the health system to identify and treat patients with SpA. Methods Survey comprised a two-stage approach with a sample of urban population in 2 areas: Belgrade, located in the north and Cacak, Uzice and Krusevac in the south, covering 36.5% of the total Serbian population. In a detection phase, every 100-th telephone number was contacted to answer a previously validated screening telephone questionnaire. Confirmation of cases was by contact with the patients rheumatologist or rheumatological examination. Prevalence results were standardized for age and sex according to Serbian population (national census 2002). Confirmed SpA cases were asked two more questions: “How long had you had symptoms before you were given the diagnosis of SpA” and “How had you been treated for that period of time”. Results 6213 people were contacted; 63.6% answered the survey; 66 were examined. A total of 16 SpA cases were identified (5 newly diagnosed). The standardized SpA prevalence for the north was 0.28% (95% confidence interval [95% CI] 0.08;0.48); 0.31 (95% CI 0.00;0.65) for men and 0.25% (95% CI 0.01;0.49) for women; for the south 0.42% (0.02;0.82); 0.41 (0.02;0.81) for men and 0.43% (0.04;0.82) for women. Mean (SD) time (months) to SpA diagnosis was 23.6 (24.9) for the north and 13.6 (11.3) for the south; 19.2 (20.2) for Serbia. Before they were given the SpA diagnosis, all patients were treated with NSAIDS, but mostly “on demand” (56.2%), some of them with physical therapy (43.7%) and benzodiazepins (18.7%). Conclusions SpA prevalence in Serbia does not differ much between southern and northern part of the country as well as between women and men. Diagnostic delay for SpA is 19 months and most of the patients were inadequately treated for that period of time. One third of the revealed SpA cases were not diagnosed previously. Disclosure of Interest None declared

Prevalence of spondyloarthritis in Serbia: a EULAR endorsed study

In order to determine the burden of inflammatory rheumatic diseases across Europe, the European League Against Rheumatism (EULAR) unique-methodology prevalence survey of rheumatoid arthritis (RA) and spondyloarthritis (SpA) was carried out in several European countries, including Serbia. Aiming to enable comparable results, it comprised a common two-stage approach: a detection phase (validated screening telephone questionnaire, primarily tested in France1 ,2) and a confirmation phase (according to a certified rheumatologist or, for previously non-diagnosed cases, a rheumatology examination). The Serbian SpA prevalence survey was conducted by 30 trained interviewers on urban population in four Serbian towns: Belgrade (north), and Cacak, Krusevac and Užice (south), by telephone (every 100th telephone number) from April to October 2008. The sample covered 36.5% of the total Serbian population with more than 99% Caucasians, mostly orthodox Serbs (83%), <4% Hungarians, Gypsies and Bosnians and a minority of other nationalities. Respondents were asked whether they have (or …

PReS-FINAL-2283: Systemic lupus erythematosus (SLE) in children and adolescents in pediatric unite, institute of rheumatology Belgrade, Serbia

SLE is an autoimmune disease characterized by widespread inflammation of blood vessels and connective tissues.

PReS-FINAL-2144: Bone mineral status in patients with juvenile idiopathic arthritis after 12 months of treatment with etanercept

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease of childhood. It is associated with decreased bone mineral density (BMD), as result of disturbance of bone metabolism which develops gradually and progressively influenced by many factors, presumably by disease severity.

Ability of the Childhood Health Assessment Questionnaire in predicting outcome of patients with juvenile idiopathic arthritis

INTRODUCTION Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease associated with decreased functional capacity and potentially long-term consequences. The establishment of early prognostic factors could help in the prevention of joint damage and improve the quality of life in children with JIA. OBJECTIVE The aim of the study was to evaluate the functional status of children with JIA by using the Childhood Health Assessment Questionnaire (CHAQ) and to assess its ability in predicting the outcome of the disease. METHODS The study included 87 patients, average age 14 years, under follow-up on the average of 3.7 years. Parents/ patients over 12 years completed CHAQ based on which disability index (DI) was calculated. Disease outcome was determined according to the preliminary criteria for clinical remission. RESULTS At the end of the follow-up period, functional ability improved significantly (0.541 vs. 0.398; p<0.05). During the study, in 52.8% of patients treatment with biologic drug etanercept was introduced. CHAQ showed good predictive validity when a baseline DI was compared with disease outcome at the final examination (F=18.349; p<0.001). Using the patients with normal functional ability (DI=0) as the reference group, in patients with moderate and more severe functional disability the odds ratio for the disease to be active at the end of the follow-up period (DI> or =0.6) was 4.6 (p=0.044). CONCLUSION Functional ability of patients with JIA significantly improved during the follow-up period owing to the efficient therapy. The questionnaire for the assessment of the functional status is a simple tool, with good ability to predict disease outcome, and should thus be used in everyday clinical practice with the aim to identify patients with poor prognosis.

Does childhood health assessment questionnaire can predict outcome of patients with juvenile idiopathic arthritis

Method 87 pts. (f 69%, m 31%) average age 14,1 yrs. disease duration 5,2 yrs., were follow up for 3,7 (2-5) yrs. Parents/ patients over 12 yrs. completed CHAQ at the beginning and at the end of study and disability index (DI) was calculated. CHAQ DI=0 was considered as normal, 0,1250,5=mild, ≥0,6=moderate/severe disability. Fifty nine (67,8%)pts. were treated with methotrexate, 42 (52,8%)pts. with etanercept. Outcome was defined as active disease or remission (Wallace criteria) [1]. We used regression models for the assessment predictive strength of CHAQ.