S.Y. Lee

Severe inflammation may be caused by hyperferritinemia of pseudo-pseudo Meigs' syndrome in lupus patients: two cases reports and a literature review

Pseudo-pseudo Meigs syndrome or Tjalma syndrome is a rare manifestation of patients with systemic lupus erythematosus defined by the presence of ascites, pleural effusions, and an elevated cancer antigen 125 level. In this case, we described a patient with lupus who presented with sudden impaired renal function and subsequent development of massive ascites with marked high serum ferritin. Hyperferritinemia is one of the abnormal laboratory findings in severe inflammation with ferritin functioning as an inflammatory marker. However, its correlation with lupus activity remains unclear. Therefore, a review of the literature regarding pseudo-pseudo Meigs syndrome associated with lupus and high ferritin level in this disease was carried out.

Jejunal vasculitis in patient with rheumatoid arthritis: case report and literature review

A 57-year-old man with rheumatoid arthritis presented severe abdominal pain symptomatic of panperitonitis. Computer tomography findings were consistent with vasculitis on the jejunum. Confirmatory angiography was conducted. Since abdominal vasculitis in rheumatoid arthritis is very rare, early diagnosis and treatment should be done according to clinical manifestation. In this case, high-dose steroid treatment was applied based on clinical manifestation, laboratory findings, and radiologic finding. After therapy, clinical manifestation and flare-up arthritis diminished.

AB0168 IL-6 Maybe A Crucial Role in Peripheral Arthritis of Non-Radiographic Axial Ankylosing Spondylitis by Toll-Like Receptor 2 and 4

Background The blocking of IL-6 therapy is not effective treatment of ankylosing spondylitis (AS) in recent report, but the role of blocking IL-6 on peripheral joint in non-radiographic axial AS is unknown. Objectives we studied the blocking of IL-6 in peripheral arthritis of non-radiographic axial AS via Toll like receptors. Methods Synovial fibroblast (FLS) were obtained from knee of eight non-radiographic axial AS patients who were high BASDAI score (>6), and six RA patients who were moderate DAS28 score (>3.2). The expression of IL-6 was analyzed by real-time polymerase chain reaction and multiplex secretary protein analysis technology, Bio-plex assay, also the expression of toll like receptor (TLR) in FLS was detected by western blot. Results The expression of TLR 2 and TLR 4 were observed on AS and RA FLS. The administration of peptidoglycan for TLR 2 and LPS for TLR 4 increased the level of IL-6 in AS and RA FLS. The treatment of AS FLS with IL-6 inhibitor, tocilizumab, resulted in reduced expression of TLR 2 and TLR 4 in AS FLS and re-administration of peptidoglycan for TLR 2 and LPS for TLR 4 treatment did not increased the expression of IL-6, TLR 2 and TLR 4 in AS FLS. Conclusions Our results suggest that IL-6 maybe crucial role in peripheral arthritis of non-radiographic axial AS and blocking of IL-6 may ameliorate peripheral arthritis of AS by regulating TLR 2 and TLR 4, so inhibition of IL-6 maybe a potential therapeutic strategy in peripheral arthritis of non-radiographic axial AS. References Treatment of non-radiographic axial spondyloarthritis: it is only the beginning. Ann Rheum Dis June 2013 Vol 72 No 6 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3901

AB0975 Diffusion Weight Magnetic Resonance Imaging May Predict A Treatment Response in Ankylosing Spondylitis

Background With the today`s advanced magnetic resonance imaging (MRI) techniques, the pathologic features of ankylosing spondylitis (AS) can be detected early and promptly treatment. Objectives This study aimed to determine the value of diffusion-weighted MR imaging (DWI) in determined of AS treatment strategy and assess the role of quantitative MRI in the evaluation of AS treatment outcome. Methods 52 patients with the diagnosis of early AS were included in this study. Disease activity was measured according to clinical instruments and laboratory tests. For each patient, both inflamed sacroiliac (S-I) joint lesion was checked quantitatively at first diagnosis by diffusion-weighted MR imaging (DWI) and measured the apparent diffusion coefficient (ADC). Based on ADC value, low ADC value group were treated with conventional NSAIDs and high ADC value group were treated with TNF-α inhibitor. all subjects were revaluated continuously by pelvis multi-directional computer tomography (MDCT) for bone change in sacroiliac joint, after treatment. Results The high ADC value patient had higher BASDIA score, ESR and CRP than low ADC value patients relatively. The clinical parameters diminished significantly with regression of the inflammatory activity after treated with TNF-α inhibitor or NSAIDs. But paradoxically, one patient who was low ADC value and treated with NSAID had radiologic change of S-I joint and no change of ADC value in follow up MRI. Conclusions The ADC value measured by DWI maybe predicted treatment response. References Braun J, Sieper J. Ankylosing spondylitis. Lancet 2007;369:1379–90. Disclosure of Interest None declared

AB0753 Diffusing Weight Magnetic Resonance Imaging May Suggest the Treatment Strategy in Ankylosing Spondylitis

Background With the advanced MRI techniques, pathologic features can be detected at an early stage and quantitatively evaluated, resulting in the advantages of early diagnosis and prompt treatment. Objectives This study aimed to determine the value of diffusion-weighted MR imaging (DWI) in determined of ankylosing spondylitis (AS) treatment strategy and assess the role of quantitative MRI in the evaluation of AS treatment outcome. Methods 18 patients with the diagnosis of early AS were included in this study. Disease activity was measured according to clinical instruments and laboratory tests. For each patient, both inflamed sacroiliac (S-I) joint lesion was checked quantitatively at first diagnosis by diffusion-weighted imaging (DWI) measuring the apparent diffusion coefficient (ADC) and by dynamic contrast-enhanced imaging (DCEI) with evaluation of the enhancement factor (fenh) and enhancement gradient (genh). All patients were revaluated by pelvis computer tomography (CT) for bone change in S-I joint, after two year. Results Clinical and quantitative MRI parameters diminished significantly with regression of the inflammatory activity. Median ADC values in AS patients were (1.118±0.122)×10-3 mm2/s in S-I joint. The high ADC (>1.118±0.122)×10-3 mm2/s, fenh (>1.65) and genh (2.09%/S) were associated severe disease activity (high BASDIA), and early administration of biologics (p<0.05). In each individual, the high ADC, fenh and genh of S-I joint lesion was associated more severe localized pain than the other S-I joint, despite treatment (p<0.05). Paradoxically, early administration of biologics group that had high ADC, fenh, genh and high disease activity, had minimal bone change of S-I joint, compared to only NSAIDs used group in pelvis CT finding. Conclusions Diffusion-weighted imaging and DCEI were shown to be effective in quantifying changes in inflammation in S-I joint at the diagnosis of AS, and could be convenient for assessing treatment strategy. To the best of our knowledge this is the first time DWI was used to evaluate the treatment strategy and treatment outcome of AS. Acknowledgements No Disclosure of Interest None declared

AB0876 Nonsteroidal Anti-Inflammatory Drugs Had Synergistic Effect on Bone Mineral Density in Bisphosphonate Treatment Osteoarthritis Patients, Compared to Cox-2 Inhibitor

Background The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and Cox-2 inhibitor are known to inhibit synthesis of prostaglandins and may prevent bone loss, but there is no study that shown the distinction between NSAIDs and COX-2 inhibitor on bone mineral density (BMD).We hypothesized the subject of NSAIDs use would be associated with increased BMD than the subject of Cox-2 use. Objectives The purpose of this study was compared the change of the BMD between NSAID use group and COX-2 inhibitor use group. Methods Between January 2005 and September 2011, we identified postmenopausal women with osteoporosis (T score >-2.5) and osteoarthritis treated with Cox-2 inhibitor (Celebrex, n=319) and NSAIDs (aceclofenac, n=104), who underwent a BMD measurement by dual-emission X-ray absorptiometry (DXA) every one year and structured interview in the 5th year of this study. The all subjects were taken bisphosphonate and the outcome measure was present difference in BMD (g/m2) and T-score. The affecting factors for elevated BMD evaluated included sex, age, BMI, disease duration, cumulative period of NSAIDs, COX-2 inhibitor and bisphosphonate. After extracting possible affecting factors through univariate analysis, multivariate logistic regression analysis was performed with backward selection to derive affecting model for increased BMD in patients with osteoarthritis. Results After adjustment for possible confounders, daily use of NSAIDs users were associated with a higher BMD at whole L-spine (2.54% 1.7-3.1 CI) and both hip (1.21%, 0.6-2.4 CI) than Cox-2 inhibitor users. Also, T-score was higher in NSAIDs users than Cox-2 inhibitor users. Univariate analysis revealed that old age (P=0.008), low BMI (P=0.001), and cumulative period of NSAIDs, COX-2 inhibitor and bisphosphonate (P<0.001) were possible affecting factors. Multivariate logistic regression analysis showed that cumulative period of NSAIDs, COX-2 inhibitor and bisphosphonate [odds ratio (OR) 4.86, 95% CI 1.27 - 18.55, P=0.021) are factors for increased BMD in patients with osteoarthritis and osteoporosis. Conclusions Daily use of NSAIDs is synergistic effect on BMD than daily use of Cox-2 inhibitor in postmenopausal women with osteoporosis treated with bisphosphonate. so our results suggest that NSAIDs use is preferred to use cox-2 inhibitor in patients with osteoporosis and osteoarthritis. References Osteoporos Int (2006) 17:1410–1419. Disclosure of Interest None declared

AB0609 Saliva Variations May Make Gastro-Esophageal Reflux Disease in Sjögren Syndrome

Background The protective role of saliva in the case of esophageal exposition to gastric acid has long been studied but some contradictions still remain. Objectives The main end-point of this study was to evaluate if a qualitative and quantitative alteration in salivary secretion exists in sjögren syndrome patients affected by gastro-esophageal reflux disease (GERD). Methods 20 sjögren syndrome patients with endoscopically diagnosed GERD (LA classification A-D) and 10 sjögren syndrome patients without GERD have been evaluated; salivary tests (basal flow rate, stimulated flow rate, pH, [Na+] and [K+]) were performed, socio-demographical variables and oral GERD-related symptoms were taken into account. Results Sjögren syndrome patients with GERD and sjögren syndrome patients without GERD were found to have a similar basal flow rate but different stimulated salivary function [sjögren syndrome with GERD group mean value 0.989 ml/min (±0.48718) vs. sjögren syndrome without GERD group 1.2197 ml/min (±0.6108), pH [sjögren syndrome group mean value 8.935 (±0.471) vs. sjögren syndrome without GERD group 7.879 (±0.526)] and a higher K+ concentration. In sjögren syndrome with GERD patients we also registered a significant association with severe xerostomia [18/20 vs. 3/10] and severe an oral burning sensation [17/20 vs. 2/10]. Conclusions Our findings assess that variation of saliva is altered in sjögren syndrome with GERD patients and highlight the need for further investigations in order to define the role of saliva in the etiology of GERD in sjögren syndrome. References Early events in Sjögrens Syndrome pathogenesis: The importance of innate immunity in disease initiation. Cytokine 67 (2014) 92–101. Disclosure of Interest None declared

THU0253 Synoviocyte Apoptosis May Differentiate Responder and Non-Responder Patients to Methotrexate Treatment in Rheumatoid Arthritis

Background there is no study reporting whether MTX inhibits rheumatoid synovitis by inducing apoptosis of synoviocytes, depending on the clinical sensitivity of MTX. Objectives We aimed to evaluate whether MTX in vitro induces apoptosis in synoviocytes obtained from rheumatoid arthritis patients and whether the apoptosis inducing effect of MTX to synoviocytes is correlated with the clinical responsiveness to MTX in patients with RA. Methods We evaluated 10 patients with RA taking MTX 15-20 mg/week as the subject group (5 responders and 5 non-responders) and 5 patients with osteoarthritis (OA) and 3 patients with ankylosing spondylitis (AS) as the control group. Synoviocytes, cultured from the synovial fluid of the knee joint of each subject, were used for experiments between passages 4 and 6, and were treated with MTX. The induction of apoptosis was determined by the quantification of DNA hypoploidy by flow cytometry, nuclear morphology, caspases activation, DNA electrophoresis, and mitochondrial membrane potential measurements. Results The viability of synoviocytes treated with MTX was different between the MTX responders and nonresponders. MTX induced apoptosis in cultured synoviocytes by mitochondria- and caspase-dependent manners in the MTX responders but did not in the MTX non-responder, OA, and AS patients. Image/graph Conclusions The apoptotic responsiveness of the synoviocytes to MTX predicts the sensitivity to MTX treatment and provides a method determine the early application of TNF-α agent in RA treatment. References Wessels JA, et al(2008) Rheumatology 47, 249-55 Disclosure of Interest None Declared

AB0753 Potential of cardio-thoracic ratio measured on chest radiography for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography

Background Currently, there are no data on the association between pulmonary hypertension and chest radiography changes specific for idiopathic pulmonary arterial hypertension in lupus. Therefore, we aimed to assessthe correlation of cardio-thoracic (CT) ratiomeasured by chest radiography for predicting pulmonary hypertension estimated by echocardiography in lupus patients. Objectives This study aims to determine whether CT ratio is increased in lupus patients with pulmonary hypertesion and its correlation with disease activity and other parameters. Methods 105 patients (median 42.75±2.14 years; 10 male) who had undergone chest radiography and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived pulmonary arterial systolic pressure (PASP) of 25 mmHg. CT ratio was measured twice. 1st CT ratio was calculated at the time of enrolled trial and 2nd CT ratio was calculated after two years later. Difference between 1st and 2nd measured CT ratio, 1st CT ratio and 2nd CT ratio were then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on CT ratio was calculated. Results In the pulmonary hypertensive group, the mean PASP was 53.13±7.76 mmHg (39-104 mmHg) and there was statistical strong correlation between the increased 2nd cardiothoracic ratios and PASP (OR=0.228 p=0.002) but, not correlation with 1st cardiothoracic ratio (OR=-0.055 p=0.462) and difference between 1st and 2nd CT ratio (OR=0.044 p=0.472). Interstitial lung disease in lupus patients were associated with PASP (OR=0.277 p=0.002) statistically. The intraobserver and interobserver correlation coefficients for cardiothoracic ratios were 0.990 and 0.892. The AUC for predicting pulmonary hypertension over 25 mmHg by echocardiography was 0.668 in 1st CT ratio (P>0.05), 0.918 in 2nd CT ratio and 0.919 in difference between 1st and 2nd CT ratio (P<0.05). Conclusions Increased CT ratios of chest radiography was correlated statistically well with PASP estimated by echocardiography and could be used to predict pulmonary hypertension over 25 mmHg with high sensitivity and specificity. Acknowledgements Pulmonary hypertension in systemic sclerosis and systemic lupus erythematosus. S.R. Johnson, J.T. Granton, Eur Respir Rev 2011; 20: 122, 277–286. Disclosure of Interest None Declared