Yeong Hee Eun

Evaluation of Audiometric Test Results to Determine Hearing Impairment in Patients with Rheumatoid Arthritis: Analysis of Data from the Korean National Health and Nutrition Examination Survey

This study aimed to evaluate the association between rheumatoid arthritis (RA) and hearing impairment in the Korean adult population. Audiometric and laboratory test data from the 2010–2012 Korean National Health and Nutrition Examination Survey (KNHANES) were used for analysis. The relationship between RA and hearing impairment was analyzed, adjusting for various known risk factors associated with hearing impairment. RA was defined in the questionnaire as “RA diagnosed by a physician (yes/no) through a standardized interview.” We defined hearing impairment according to 2 categories of frequency (low/mid and high) as follows (average values in kHz): low/mid frequency, 0.5, 1.0, and 2.0, and high frequency, 3.0, 4.0, and 6.0. Of the subjects, 15,158 (weighted n = 32,035,996) completed the audiometric tests. The overall weighted prevalence of RA was 1.5%. The prevalence of hearing impairment was higher in the subjects with RA than in those without RA, in both, the low/mid- and high-frequency categories (21.1% vs 7.5%, p < 0.001 and 43.3% vs. 26.2%, p < 0.001, respectively). In the multivariable logistic analysis, RA (odds ratios [OR] 1.47, 95% confidence interval [CI] 1.05–2.06, p = 0.025) was an independent risk factor of low/mid-frequency hearing impairment along with age (OR 1.12, 95% CI 1.12–1.13, p < 0.001), current smoking (OR 1.27, 95% CI 1.03–1.56, p = 0.026), and college graduation (OR 0.53, 95% CI 0.39–0.72, p < 0.001). In the multivariable analysis of high-frequency hearing impairment, RA did not show any association with hearing impairment. This study suggests that RA is associated with low/mid-frequency hearing impairment after adjustment for various known risk factors. Further study is needed to verify the hearing impairment in RA.

Characteristics of hip involvement in patients with ankylosing spondylitis in Korea.

Background/Aims To evaluate the clinical course of hip arthritis and the risk factors for hip joint replacement in patients with ankylosing spondylitis (AS). Methods In this retrospective analysis, we evaluated 488 AS patients at a single tertiary hospital. At baseline and the most recent visit to the outpatient clinic from the patients with hip arthritis in AS, radiographic hip arthritis was evaluated using the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h). Also the average of the hip joint space width (interbone distance) at three distinct sites between the acetabulum and femoral head was recorded. Results Among 488 patients with AS, 60 patients (12.3%) had hip arthritis. Erythrocyte sedimentation rate were associated with hip involvement (odds ratio, 1.01; 95% confidence interval [CI], 1.00 to 1.02; p = 0.004). Long disease duration and advanced axial disease were associated with severe hip arthritis (3 ≥ BASRI-h) at baseline. BASRI-h and interbone distance did not significantly change in patients with hip involvement during the follow-up period of 81.4 ± 35.7 months. Five patients had hip joint replacement surgery during follow-up period. The body mass index (BMI) and BASRI-h at baseline were associated with joint replacement surgery (hazard ratio [HR], 1.30; 95% CI, 1.00 to 1.67; p = 0.049 and HR, 20.64; 95% CI, 2.39 to 178.11; p = 0.006, respectively). Conclusions Most of the patients with hip arthritis in AS showed no significant radiographic progression during the follow-up period. High BMI and advanced hip arthritis at baseline were associated with hip joint replacement surgery in patients with AS.

Estrogen attenuates the spondyloarthritis manifestations of the SKG arthritis model

BackgroundAnkylosing spondylitis (AS) is a male-predominant disease, and radiographic evidence of damage is also more severe in males. Estrogen modulates immune-related processes such as T cell differentiation and cytokine production. This study aimed to evaluate the effect of estrogen on the disease activity of spondyloarthritis (SpA).MethodsThe effects of estrogen on the development of arthritis were evaluated by performing ovariectomy and 17β-estradiol (E2) pellet implantation in zymosan-treated SKG mice. Clinical arthritis scores were measured, and 18F-fluorodeoxyglucose (18F-FDG) small-animal positron emission tomography/computed tomography performed to quantify joint inflammation. The expression of inflammatory cytokines in joint tissue was measured.ResultsE2-treated mice showed remarkable suppression of arthritis clinically and little infiltration of inflammatory cells in the Achilles tendon and intervertebral disc. 18F-FDG uptake was significantly lower in E2-treated mice than in sham-operated (sham) and ovariectomized mice. Expression of TNF, interferon-γ, and IL-17A was significantly reduced in E2-treated mice, whereas expression of sclerostin and Dickkopf-1 was increased in E2-treated mice compared with sham and ovariectomized mice.ConclusionsEstrogen suppressed arthritis development in SKG mice, a model of SpA. Results of this study suggest that estrogen has an anti-inflammatory effect on the spondyloarthritis manifestations of the SKG arthritis model.

OP0194 The association between serum uric acid and arterial stiffness in a low-risk, large population of middle-aged korean

Background Arterial stiffness occurs because of biologic ageing and arteriosclerosis, and is most commonly measured by pulse-wave velocity. Several studies have reported that high serum uric acid may contribute to the development of a number of metabolic and haemodynamic abnormalities, and multivariate analyses in epidemiologic studies have suggested that hyperuricemia is an independent risk factor for arterial stiffness in those with comorbidities such as diabetes, hypertension, and chronic kidney disease. However, there are few reports about the association between SUA and arterial stiffness in apparently healthy populations. Objectives We aimed to investigate the association between serum uric acid (SUA) and arterial stiffness as evaluated by brachial ankle pulse wave velocity (baPWV) in a low-risk, large, middle-aged Korean population. Methods We conducted a cross-sectional study of 66,917 Koreans (38u2009170 men, 28u2009747 women) who received yearly screening with available PWV and SUA results. None of the participants had coronary heart disease, diabetes, or hypertension. SUA was divided into quintiles for assessment of its association with baPWV by multiple linear regression analysis. Results The average SUA level was 5.23±1.4u2009mg/dl, and SUA values were higher in men than in women (6.1±1.2u2009mg/dl vs 4.1±0.8u2009mg/dl). In multiple regression analysis, PWV was significantly higher in SUA quintiles 2–5 compared to the lowest group (reference) (coefficient=11.52, 18.19, 24.73, and 31.02 cm/s, respectively). In female subjects, the average difference (cm/s) of PWV between quintiles 2–5 and quintile 1 of SUA was 13.1, 22.9, 34.6, and 32.1, respectively. Fully adjusted linear coefficient β (S.E.) was 6.62 (0.70) and 12.43 (1.33) in all participants and female subjects, respectively (p<0.001). In contrast, there was a J-shaped association between PWV and SUA quintile among males. When modelled continuously, each 1u2009mg/dlu2009higher SUA level was associated with 0.27 higher baPWV (p<0.001) in the adjusted analysis. Conclusions These findings indicate that higher SUA levels could have an unfavourable impact on arterial stiffness as measured by baPWV in a low-risk, large, middle-aged Korean population. Disclosure of Interest None declared

Clinical characteristics and outcomes of 61 patients with chronic periaortitis including IgG4-related and non-IgG4-related cases

Chronic periaortitis (CP) is a disease characterized by a fibro‐inflammatory periaortic cuff and adventitia‐predominant fibrosis. CP encompasses idiopathic retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm (AAA), and recent studies have documented overlap between CP and immunoglobulin G4‐related disease (IgG4‐RD). This study aimed to investigate clinical characteristics and treatment outcomes of patients with CP.

AB0273 Disease Characteristics and Change of Arthritis Activity According To Treatment in Hepatitis B Surface Antigen Positive Rheumatoid Arthritis Patients

Background Rheumatoid arthritis (RA) treatment may differ according to hepatitis B state and consequently bring about different outcome of arthritis. Only a small number of studies have addressed the differences in disease characteristics and treatment patterns of RA in relation to hepatitis B state. However, it has not yet been elucidated whether hepatitis B affects treatment outcome such as disease activity. Objectives We investigated possible differences in change of arthritis activity between RA patients according to concomitant hepatitis B virus (HBV) infection. Methods A retrospective analysis of 40 hepatitis B surface antigen (HBsAg)-positive RA patients and 112 HBsAg-negative RA patients was conducted. The longitudinal relationship between HBsAg-positivity and RA activity/medication use was analyzed using generalized estimating equations in regression models. Results There were no significant differences in group for baseline characteristics. In regression analysis, RA activity-related outcomes showed follow-up time-dependent improvement during study period. We observed significant interaction between time and HBsAg-positivity for disease activity score in 28 joints with 3 variables (DAS28–3; P =0.026), that means decreases in DAS28–3 with time influenced by HBsAg-positivity. But this interaction did not remain significant after adjustment. For tender joints, erythrocyte sedimentation rate, and C-reactive protein levels, there were no interaction between time and HBsAg-positivity, while swollen joints showed significant interaction (P =0.017). The time-association and group differences were not observed in alanine aminotransferase (ALT) level. Over all visits, HBsAg-positive patients were less likely to receive methotrexate (OR 0.09 [95% CI 0.04–0.19], P <0.0001) and more likely to receive sulfasalazine (OR 3.67 [95% CI 1.94–6.95], P <0.0001). In HBsAg-positive RA patients, initial hepatitis B state was related to use of DMARDs, especially methotrexate (P =0.040). Hepatitis reactivation occurred in 4 patients (10%) in HBsAg-positive RA patients. Among the patients who experienced HBV reactivation, only one patient had received previous antiviral treatment at baseline, but the patient exhibited lower adherence to drug. All patients who experienced HBV reactivation showed positive HBV DNA at baseline. There were no cases of hepatic failure or death. Conclusions There were no significant differences over time in DAS28–3, tender joints, inflammatory markers, according to HBsAg-positivity, while swollen joints showed significant difference over time. ALT level did not showed time-association and group differences. HBsAg-positive RA patients were less likely to receive methotrexate and more likely to receive sulfasalazine. Disclosure of Interest None declared

AB0793 Clinical Characteristics of Hip Arthritis in Patients with Ankylosing Spondylitis in Korea

Objectives This study aimed to evaluate the clinical characteristics and associated factors of hip arthritis in patients with ankylosing spondylitis (AS). Methods A retrospective analysis evaluated 488 patients of AS with hip arthritis at a single tertiary hospital in South Korea. Hip arthritis was assessed by Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) and the average joint space width of the hip joint at three distinct sites that are in between the acetabulum and femoral head at baseline and last visit of outpatient clinic. Clinical and laboratory characteristics were collected. Results Among 488 patients with AS, 60 (12.3%) patients had hip arthritis. Body mass index (BMI) and erythrocyte sedimentation rate (ESR) were associated with hip involvement in AS (OR 1.11, 95% CI 1.03 to 1.19, p=0.008 and OR 1.01, 95% CI 1.00 to 1.02, p=0.005, respectively). The mean X-ray follow-up duration was 81.4±35.7 months. During the follow-up period, ESR and C-reactive protein (CRP) decreased significantly and there was no significant radiographic change in the hip joints. Among 60 patients, 7 (11.7%) patients had radiographic progression of the hip joints and 5 (8.3%) patients had hip replacement surgery. The BMI tended to be higher in patients with radiographic progression of the hip joints than in those without (23.4±4.2 vs. 26.6±3.9, p=0.068). Conclusions Most of the patients with hip arthritis in AS had no significant radiographic progression during the follow-up period. BMI was associated with hip involvement in patients with AS. Disclosure of Interest None declared

FRI0352 Decline of Lung Function is Associated with the Presence of Rheumatoid Factor in Korean Subjects Without Clinically Apparent Lung Diseases

Background Rheumatoid factor (RF) is an autoantibody directed against the Fc component of IgG. It is present in approximately 70-80% of rheumatoid arthritis (RA) patients but also found nonspecifically in chronic inflammatory condition such as sarcoidosis, hepatitis B or C, and tuberculosis. Meanwhile, in relation to RA-related autoantibodies, airways abnormalities were reported in patients without inflammatory arthritis and the lung has been suggested as a potential site of generation of RA-related autoimmunity. In subjects without any specific medical problem, however, the influence of RF to lung function is infrequently known. Objectives This study aimed to determine the effect of the presence of RF on pulmonary function in a large number of Korean healthy subjects without any history of joint disease and clinically apparent lung diseases. Methods Of the 114,944 people who participated in a health checkup program in 2010, 94,438 subjects with normal chest radiography were recruited, whose results of RF and pulmonary function test (PFT) using spirometry were available. Subjects with arthralgia or the past medical history of arthritis including RA, and lung diseases were excluded based on self-reported questionnaire. Association between RF and PFT was assessed by correlation analysis. Results Among 94,438 people, RF was positive in 3,326 subjects (3.52%). Their mean age was 41.3±8.3 (range, 21 – 83) and 43.8% were female; these characteristics were not significantly different from those of RF-negative subjects, whose mean age was 41.3±8.3 (range, 18 – 88) and 43.7% female. Ever-smokers (ex- and current smokers) were 39% in RF-positive subjects while 41.2% in RF-negative subjects (p=0.009). Hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibodies (anti-HCV) were more frequently seen in RF-positive subjects (12.1% vs. 3.5%, p<0.001 for HBsAg and 0.5% vs. 0.1%, p<0.001 for anti-HCV). Regarding PFT, RF-positive subjects had lower forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) compared to RF-negative subjects (3.79±0.83 L vs. 3.87±0.83 L, p<0.001 and 3.17±0.66 vs. 3.25±0.67 L, p<0.001). The proportion of subjects with FVC below 82% and FEV1 below 84% of the predicted value was significantly higher in RF-positive subjects (50.7% vs. 46.6%, p<0.001 and 54.5% vs.49.4%, p<0.001) but the frequency of airflow limitation (FEV1/FVC ≤70%) did not differ between two groups (1.4% vs. 1.5%, p=0.47). FVC and FEV1 had negative correlations with the RF titers and the strength was very weak (r = -0.053, p<0.001 in FVC and r = -0.055, p<0.001 in FEV1). Conclusions The results suggest that RF could impact on lung function in healthy subjects without clinically apparent lung diseases. A follow up study for the serial changes of PFT may reflect the actual influence of the raised RF titers. Disclosure of Interest None declared

FRI0266 A Comparative Metabolomic Evaluation of Behcet's Disease with Arthritis and Seronegative Arthritis Using Synovial Fluid

Background Behcets disease (BD) is a chronic, complex systemic vasculitis of unknown etiology characterized by orogenital ulcers, uveitis, and arthritis. Arthritis and arthralgias in BD are known to be the most common rheumatologic findings with a prevalence ranging from 40 to 70%. However, arthritis in BD is often confused with seronegative arthritis (SNA) including seronegative spondyloarthropathy (SNSpA) and seronegative rheumatoid arthritis (SNRA) because of shared clinical symptoms and the lack of definitive biomarkers for BD. Objectives The purpose of this study was to evaluate the metabolomic profiling of synovial fluid (SF) from patients with arthritis in BD and SNA to investigate possible metabolic patterns and potential biomarkers for arthritis in BD. Methods SF samples were collected from BD patients with arthritis (n=6, mean age 34.8±16.4 years), SNSpA (n=13, mean age 30.9±11.0 years), and SNRA (n=5, mean age 65.8±10.7 years). Metabolomic profiling was performed by gas chromatography/time-of-flight mass spectrometry in conjunction with univariate and multivariate statistical analyses. Results A total of 123 metabolites were identified from samples. Orthogonal partial least square-discriminant analysis showed clear discrimination between arthritis in BD and SNA. A set of 11 metabolites were identified as potential biomarkers for arthritis in BD using variable importance for projection values and the Wilcoxon-Mann-Whitney test. Compared with SNA, arthritis in BD exhibited relatively high levels of glutamate, valine, citramalate, leucine, methionine sulfoxide, glycerate, phosphate, lysine, isoleucine, urea, and citrulline. There were two markers identified, elevated methionine sulfoxide and citrulline, that were associated with increased oxidative stress, providing a potential link to BD-associated neutrophil hyperactivity. Glutamate, citramalate, and valine were selected and validated as putative biomarkers for arthritis in BD (sensitivity, 100%; specificity, 61.1%). Conclusions This is the first report to present potential biomarkers from SF for discriminating arthritis in BD from SNA. The metabolomics of SF may be helpful in searching for potential biomarkers and elucidating the clinicopathogenesis of arthritis in BD. Acknowledgements This work was supported by the Advanced Biomass R&D Center of Korea (2011-0031353), the National Research Foundation of Korea funded by the Ministry of Education (NRF-2013R1A1A2059103), and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare (HI14C2285), which are funded by the Korean Government. Experiments were performed using facilities of the Institute of Biomedical Science and Food Safety at the Korea University Food Safety Hall. Disclosure of Interest None declared