Zaiying Hu

Adalimumab significantly reduces inflammation and serum DKK‐1 level but increases fatty deposition in lumbar spine in active ankylosing spondylitis

To investigate whether adalimumab is effective for active ankylosing spondylitis (AS) patients and whether it has an impact on the formation of fatty deposition lesions (FDL) and serum Dickkopf homolog 1 (Dkk‐1) level in AS patients.

The Ankylosing Spondylitis Disease Activity Score is a highly discriminatory measure of disease activity and efficacy following tumour necrosis factor-α inhibitor therapies in ankylosing spondylitis and undifferentiated spondyloarthropathies in China

OBJECTIVE To validate the clinical value of the new Ankylosing Spondylitis Disease Activity Scores (ASDASs) in assessing the disease activity and efficacy of TNF-α inhibitor in AS and uSpA patients in China. METHODS Two hundred and thirty patients were included in our study. They consisted of patients with active AS (n = 87) and uSpA (n = 30) participating in a double-blind placebo-controlled randomized clinical trial of etanercept and patients with active AS (n = 58) and uSpA (n = 55) treated with infliximab. The disease activity and treatment effects were assessed by ASDAS, BASDAI, patient global and the acute inflammation score of lumbar and SI joints by MRI. Discriminatory ability of all the measures was analysed by standardized mean difference and t-score. RESULTS In both the AS and uSpA groups, ASDAS correlated well with patient global score (AS group: r = 0.65-0.72; uSpA group: r = 0.52-0.62), ESR (AS group: r = 0.57-0.81; uSpA group: r = 0.63-0.85) and CRP (AS group: r = 0.51-0.70; uSpA group: r = 0.61-0.76) both at baseline and in changes from baseline to 6 weeks after TNF-α inhibitor treatment. The ASDAS scores outperformed BASDAI, patient global score, ESR, CRP and the acute inflammation score by MRI in differentiating patients with different levels of disease activity and patients with different levels of change in both AS and uSpA groups. There was little difference in performance between the two versions of the ASDAS. CONCLUSION The new ASDAS is a highly effective measure in assessing disease activity and a great discriminatory measurement to assess the efficacy of TNF-α inhibitor in Chinese AS patients and uSpA patients.

Higher risk of uveitis and dactylitis and older age of onset among ankylosing spondylitis patients with HLA-B*2705 than patients with HLA-B*2704 in the Chinese population.

Human leukocyte antigen (HLA)-B27 is closely associated with ankylosing spondylitis (AS). However, the exact correlation between HLA-B27 subtypes and AS manifestations remains unknown. This study aimed to investigate the correlation between HLA-B27 polymorphism and the clinical features of AS. This study included 846 patients with AS and 959 healthy controls. Direct sequencing was used to identify the HLA-B27 genotype. Clinical parameters, including age, age of onset, family history, low back pain, peripheral arthritis, hip joint involvement, dactylitis, uveitis, and sex ratio, were compared among patients with various HLA-B27 subtypes. In total, 741 AS patients (87.6%) and 39 healthy controls (4%) were HLA-B27-positive. The most prevalent subtypes were HLA-B*2704 (88%) and HLA-B*2705 (10.1%) in patients with AS. Compared with HLA-B*2704-positive patients, HLA-B*2705-positive patients demonstrated a significant increase in the incidence of uveitis (16% vs 6.13%, P = 0.002) and dactylitis (9.3% vs 3.8%, P = 0.028) and they had an older age of onset (22.9 ± 8.0 vs 20.7 ± 6.7 years, P = 0.028). Binary logistic regression analysis revealed that presence of uveitis was significantly associated with HLA-B*2705 (P = 0.008; odds ratio, 2.63; 95% confidence interval, 1.283-5.393). There were no significant differences in family history, low back pain, peripheral arthritis, or hip joint involvement among HLA-B27 subtypes. Specific HLA-B27 subtypes were positively associated with particular clinical features of AS. AS patients with HLA-B*2705 demonstrated an older age of onset and had a higher risk of uveitis and dactylitis than did AS patients with HLA-B*2704.

Epidemiological comparison of clinical manifestations according to HLA-B*27 carrier status of Chinese Ankylosing Spondylitis patients

The aim of the study was to investigate and compare the clinical manifestations between HLA-B27(+) and HLA-B27(-) ankylosing spondylitis (AS) patients in order to obtain knowledge of the impact of HLA-B27 status on AS, and to inform clinical treatment. A nationwide epidemiological investigation was performed from November 2008 to October 2010. The demographic data and clinical characteristics, and the status of HLA-B27 were collected using questionnaires and laboratory assay, respectively. A total of 2144 patients (78.5% males and 78.4% HLA-B27(+) AS patients) participated in this study. The percentages of males, patients with family history, and involvement of lumbar spine, thoracic spine and hip joints, were observed to be significantly higher in the HLA-B27(+) AS patients than in their HLA-B27(-) AS peers.

Evaluation of Assessment of Spondyloarthritis International Society classification criteria for axial spondyloarthritis in Chinese patients with chronic back pain: results of a 2‐year follow‐up study

To evaluate the diagnotic value of the Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axial spondyloarthritis (SpA) in Chinese patients with chronic back pain and without radiographic sacroiliitis in a 2‐year follow‐up study.

Serum from patients with ankylosing spondylitis can increase PPARD, fra-1, MMP7, OPG and RANKL expression in MG63 cells

OBJECTIVES: To explore the effects of serum from patients with ankylosing spondylitis on the canonical Wnt/β-catenin pathway and to assess whether the serum has an osteogenic effect in MG63 cells. METHODS: MG63 cells were cultured with serum from 45 ankylosing spondylitis patients, 30 healthy controls, or 45 rheumatoid arthritis patients. The relative PPARD, fra-1, MMP7, OPG and RANKL mRNA levels were measured using quantitative real-time polymerase chain reaction. Associations between gene expression and patient demographics and clinical assessments were then analyzed. RESULTS: MG63 cells treated with serum from ankylosing spondylitis patients had higher PPARD, fra-1, MMP7 and OPG gene expression than did cells treated with serum from controls or rheumatoid arthritis patients (all p<0.05). RANKL expression was higher in MG63 cells treated with serum from patients with ankylosing spondylitis or rheumatoid arthritis than in those treated with serum from controls (both p<0.05). The OPG/RANKL ratio was also higher in MG63 cells treated with serum from ankylosing spondylitis patients than in those treated with serum from controls (p<0.05). No associations were found between the expression of the five genes and the patient demographics and clinical assessments (all p>0.05). CONCLUSIONS : Serum from ankylosing spondylitis patients increases PPARD, fra-1, MMP7, OPG and RANKL expression and the OPG/RANKL ratio in MG63 cells; these effects may be due to the stimulatory effect of the serum on the Wnt pathway.

AB0679 Mardrid Sonographic Enthesis Index Scoring System Is Sensitive for Asymptomatic Peripheral Enthesitis in Early Axial Spondyloarthritis

Background Mardird sonographic enthesis index (MASEI) was one of the most wide used scoring systems for enthesitis not only used in spondyloarthropathy (SpA) but also in the other disease such as enthesitis in Behcets disease. However, no articles mentioned its role in early diagnose in the early axial SpA without peripheral syndromes yet. Objectives Our study is to find out the role of MASEI in diagnosis of early axial SpA. Methods Ultrasound was performed by 2 observers blinded to the other examinations and the final diagnosis. All cases were diagnosed as early axial SpA fulfilling 2009 classification criteria but not 1996 New York Criteria with sacroilliac X-ray and MRI.US examination referred to MASEI related regions. BASDI, ASDAS were employed to assess disease activity. MRI was synchronized done for the position with positive findings by ultrasound to make sure the accuracy of the enthesitis. Results 1) 168 early axial SpA subjects without proof for peripheral enthesitis including physical examination or past history were screened by ultrasound.47 (28.0%) were made diagnosis as perpheral enthesitis by US and 45 (25.6%) were comfirmed by MRI. Mean age of 45 was 29.3 yrs, female-male ratio was 0.36:1, and disease duration was 0.89 yr. Positive HLA-B27 patients were more than HLA-B27negative ones (4:1). 2) The average of MASEI scores were low level (7.26±2.36). No significant differences between HLA(+) and HLA(−) groups. However, the scores for male patients group was higher than female ones (Sig=0.002), especially in respect of tendon thickness, tendon structure disturbance and bone erosion (Sig=0.000,0.001, 0.011). 3) The most common US findings were the chronic presentations as bone erosion, bone calcification. (75.6%, 84.4%) which suggested the enthesis aggression in asymptomatic patinets is a long-term slow change. Conclusions Our study found MASEI assessment is good tool for early diagnosis and follow up for peripheral enthesitis in early axial SpA and the US positive findings might be earlier than the clinical presentations. Disclosure of Interest None declared

AB0267 No Remarkable Differences on Sonograms of Wrist, Metacarpophalangeal and Proximal Interphalangeal Joints between Rheumatoid Factor Negative Rheumatoid Arthritis and Rheumatoid Factor Positive Rheumatoid Arthritis Patients

Background It is reported RF-negative Rheumatoid Arthritis (RF-nRA) had distinct genetic background and pathogenesis mechanism leading to different prognosis and therapy response from RF-positive Rheumatoid Arthritis (RF-pRA). Ultrasound (US) of wrist, metacarpophalangeal (MCP) and proximal interphalangeal joints (PIP) which are the classical zone of RA involvement might verify whether the joint destruction would be different in both group. Objectives To verify whether the joint destruction would be different in RF-negative Rheumatoid Arthritis (RF-nRA) and RF-positive Rheumatoid Arthritis (RF-pRA) patients. Methods It is a blinded, controlled trial. All cases including RF-nRA group and RF-pRA group satisfied 2009 classification criteria with abnormal swollen or pain in wrists, AMCPs or PIPs. RF-pRA group should have x-ray or MRI evidences The most affected side of joints including the 2nd, 3rd MCPs, Athe 2nd, 3rd PIPs and wrists were examined. US examination and scoring system referred to Backhauss US7 scoring system related regions. In addition, synovitis in gray-scale US (GSUS) on dorsal side of the 2nd, 3rd MCPs and PIPs (0–3 grade) and bone erosions on dorso-median, ulnar, palmo-median sides (0 or 1 if absent/present) of wrist in GSUS were also counted in to get a total of 0–106 scores. DAS 28 (3 variables) was employed to divide each of the 2 groups into 4 subgroup to assess the sonograms in different disease activity levels. Results 1) 15 RF-nRA cases and 41 RF-pRA cases were enrolled. Mean age (53.8yrs, 57.2yrs), female-male ratio(29:12,16:9), and disease duration(7.53,7.88) of 2 groups were described as above. DAS-28>5.1 subgroups in both 2 groups had the most cases (RF-nRA/RFpRAremission:low:moderate:high=3:2:4:6/1:5:15:20). 2) DAS-28 had highly positive correlation(r=0.95) to US sum scores while poor positive correlation with synovitis GDUS sum scores or synovial Power Doppler(PD) signals sum scores alone.(r=0.57,0.62) 3) No significant differences between RF-nRA and RF-pRA in aspect of synovitis in GDUS, synovial PD signals, and bone erosions in GDUS in wrists, MCPs, PIPs respectively in different levels. Conclusions Our study has not found any distinctions in most affected joints between RF-nRA and RF-pRA patients. Disclosure of Interest None declared

AB0594 The Metabolic Syndrome in Chinese Patients with Systemic Lupus Erythematosus and Its Elevated Levels of Lipoprotein-Associated Phospholipase A2

Background Metabolic Syndrome (MS) may contribute to increased cardiovascular risk in the population. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is involved in the modification of lipids within atheromatous plaques. The increased prevalence of MS in SLE patients has been reported. However, few studies report the prevalence of MS in patients with SLE in southern China, and no study reveals its association with Lp-PLA2. Objectives To investigate the prevalence and clinical features of MS in patients with SLE in southern China, and to evaluate its association with Lp-PLA2. Methods 415 inpatients with SLE diagnosed in our Rheumatology Department from 2012 to 2014 were retrospectively investigated for their incidence of MS, compared with 830 age- and gender-matched general individuals. MS was defined according to the 2009 consensus statement of the International Diabetes Foundation.Data of medical records review, physical examination and laboratory tests were collected. Furthermore, SLE patients were classified according to the prevalence of MS. Plasma Lp-PLA2 level, SLE disease activity index (SLEDAI) and lupus characteristics were compared between SLE group with MS and SLE group without MS. Results There were 140 patients with SLE presented MS. The prevalence of MS in the cohort was 33.73% (140/415), significantly higher than that of the matched controls (14.22%, 118/830, P<0.05), the same both in males (30.51% vs 20.0%) and females (34.27% vs 13.27%) (P<0.05). However, no significant difference was found regarding the incidence of MS between male and female groups with SLE (30.51% vs 34.27%, P>0.05). The MS component with the highest prevalence in the SLE population was low HDL-Cholesterol (<50mg/dL) with a prevalence of 58.60%. And the ratios of patients with higher TG, higher LDL-C and impaired fasting glucose in SLE group were 33.12%, 31.74% and 19.11% respectively. The incidence of MS in the age group (44 years old) with SLE was significantly higher than that of the age-matched controls (28.45% vs 10.37%, P<0.05), but we found no significant difference in the age ranges of both 45–64 years and 65 years (P>0.05). The plasma Lp-PLA2 level of SLE group with MS was significantly higher than that of SLE group without MS (497.40 vs 324.65, ng/ml, P<0.05), while neither SLEDAI nor renal involvement showed significant difference between these two SLE groups (P>0.05). Conclusions Patients with SLE have a higher prevalence of metabolic syndrome, compared with the general population in southern China, characterized prominently by dyslipidemia. The Lp-PLA2 signatures may contribute to the increased cardiovascular risk in the SLE patients with MS. SLE patients should begin to pay attention to the occurrence of MS before 45 years old. References Sabio JM, Zamora-Pasadas M, Jimenez-Jaimez J, et al. Metabolic syndrome in patients with systemic lupus erythematosus from Southern Spain. Lupus 2008;17:849–59. Serruys PW, García-García HM, Buszman P, et al. Effects of the direct lipoprotein associated phospholipase A (2) inhibitor darapladib on human coronary atherosclerotic plaque [J]. Circulation, 2008,118 (11): 1172-1182. Colley KJ,Wolfert RL,Cobble ME.Lipoprotein associated phospholipase A (2):role in atherosclerosis and utility as a biomarker for cardiovascular risk [J]. EPMA J,2011,2(1):27-38. Disclosure of Interest None declared

THU0345 Meloxicam Inhibits the Activation of Serum From Patients with Ankylosing Spondylitis to WNT/B-Catenin Pathway on MG63

Background It had been reported that Jurkat cells treated with serum from ankylosing spondylitis (AS) patients exhibited increased Wnt signaling compared with cells treated with control serum [1]. Whether serum from AS patients also has such effect on osteosarcoma cell line MG63 is unknown. Meloxicam could down-regulate wnt pathway in adenomas [2]. Whether it could inhibit the activation of serum from AS patients to wnt pathway in MG63 has not been discussed about. Objectives To investigate whether serum from patients with AS could activate Wnt/β-catenin pathway in MG63, and whether meloxicam could inhibit this activation or not. Methods We collected serum from 45 untreated AS patients and 45 healthy volunteers. And we cultured MG63 with the serum mentioned above for two days. We also added meloxicam to MG63 after it cultured with serum from AS patients for an other day. We used western blot to detect the protein expression of active β-catenin. And we used realtime polymerase chain reaction to detect gene expression of PPARD, FOSL1, MMP7, OPG and RANKL in MG63. Results Cultured with serum from AS patients, the protein expression of active β-catenin and gene expression of PPARD, FOSL1, MMP7, OPG, RANKL in MG63 were all higher than that cultured with serum from healthy subjects (all p<0.05). While adding meloxicam subsequently, the expression of active β-catenin and PPARD, FOSL1, MMP7, OPG, and RANKL in MG63 dropped significantly (all p<0.05). Conclusions Serum from AS patients could activate Wnt/β-catenin pathway in MG63 and Meloxicam can inhibit this activation. References Daoussis D, Liossis SN, Solomou EE, et al. Evidence that Dkk-1 is dysfunctional in ankylosing spondylitis. Arthritis Rheum. 2010 Jan;62(1):150-8. doi: 10.1002/art.27231. Dobbie Z, Muller PY, Heinimann K, et al. Expression of COX-2 and Wnt pathway genes in adenomas of familial adenomatous polyposis patients treated with meloxicam. Anticancer Res. 2002 Jul-Aug;22(4):2215-20. Disclosure of Interest None Declared