Recurrent reproductive failure (RRF), encompassing repeated implantation failure and pregnancy loss, remains a major challenge in assisted reproductive technology (ART). Autoimmune factors have been implicated in adverse reproductive outcomes, but the combined impact of antinuclear antibodies (ANA) and antiphospholipid antibodies (aPL) on ART success in women with RRF is unclear. This retrospective cohort study analyzed 682 women with RRF who underwent IVF or ICSI between April 2019 and April 2024. Participants were classified into four groups based on ANA and aPL status. Clinical characteristics, laboratory indices, and ART outcomes were compared. Univariable and multivariable logistic regression analyses were conducted to identify predictors of live birth. Live birth rates differed significantly across groups (p = 0.001), with the ANA−/aPL− group showing the highest rate (36.3

Journal Article Accepted manuscript A rare case of undifferentiated connective tissue disease presenting with polyserositis Get access Qing-Ying Fang, Qing-Ying Fang Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University Search for other works by this author on: Oxford Academic PubMed Google Scholar Liu-Qin Liang, Liu-Qin Liang Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University Search for other works by this author on: Oxford Academic PubMed Google Scholar Qian Qiu, Qian Qiu Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University Search for other works by this author on: Oxford Academic PubMed Google Scholar Fan Lian Fan Lian Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University Corresponding author: Fan Lian, Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, P.R. China. E-mail: [email protected] Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, keaf018, https://doi.org/10.1093/rheumatology/keaf018 Published: 08 January 2025 Article history Received: 11 October 2024 Accepted: 29 December 2024 Published: 08 January 2025

Background Traditional live animal surgical training requires urgent alternatives due to mounting ethical concerns and substantial cost burdens. However, current simulation modalities (e.g., virtual reality platforms) remain limited in their capacity to replicate the critical haptic feedback and tissue responsiveness characteristic of open surgical procedures. Methods A randomized crossover trial (n=20) was conducted to compare the teaching effects of the intervention group (Smagister ex vivo organ perfusion system) and the control group (live Beagle dogs) in an undergraduate surgical skills course. The primary endpoints were Basic Technical Skills (BTS) and Objective Structured Assessment of Technical Skills (OSATS) scores, while secondary endpoints included ethical distress and teaching experience. Results There was no significant difference in basic skills scores between the two groups (P>0.05). The intervention group had significantly higher OSATS scores in the first phase than the live group (23.1±4.5 vs. 19.5±2.5, P=0.05), and also had certain advantages in preparation time, surgical field, and biosafety. The control group had advantages in team collaboration (recognized by 12/20) and tissue viability assessment (16/20), but there was no difference in ethical distress levels between the two groups ( P=0.7). Conclusions The Smagister system achieves parity with live animal training in educational outcomes while offering superior cost, ethical, and safety profiles, making it an optimal choice for undergraduate surgical education. Trial registration The study was registered with Medical Research Ethics Committee of the Eighth Affiliated Hospital of Sun Yat-sen University (Protocol Number: Sun Yat-sen University Affiliated Eighth Hospital Research Ethics [Animal] 2025-014-01)

To compare pregnancy outcomes between systemic lupus erythematosus (SLE) patients with thrombocytopenia and those without, and to develop a nomogram for assessing the risk of developing SLE-related thrombocytopenia during pregnancy. Clinical data from 178 pregnant patients with SLE were analyzed. Patients were classified into thrombocytopenia and normal platelet groups using a platelet count cutoff of < 100 × 10^9/L. Pregnancy outcomes were compared between these groups. A nomogram was developed to identify factors associated with thrombocytopenia based on univariate and multivariable logistic regression analyses. The performance of the nomogram was assessed through receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Among the 178 patients, 34 were in the thrombocytopenia group and 144 in the normal platelet group. SLE patients with thrombocytopenia had a significantly higher rate of active disease (55.9

Rheumatoid arthritis (RA) patients have a high prevalence for depression. On the other hand, comorbid with depression is associated with worse prognosis for RA. However, little is known about the underlying mechanisms for the comorbidity between RA and depression. It remains to be elucidated which brain region is critically involved in the development of depression in RA, and whether alterations in the brain may affect pathological development of RA symptoms. Here, by combining clinical and animal model studies, we show that in RA patients, the level of depression is significantly correlated with the severity of RA disease activity and affects patients' quality of life. The collagen antibody-induced arthritis (CAIA) mouse model of RA also develops depression-like behaviors, accompanied by hyperactivity and alterations in gene expression reflecting cerebrovascular disruption in the lateral habenula (LHb), a brain region critical for processing negative valence. Importantly, inhibition of the LHb not only alleviates depression-like behaviors, but also results in rapid remission of RA symptoms and amelioration of RA-related pathological changes. Together, our study highlights a critical but previously overlooked contribution of hyperactive LHb to the comorbidity between RA and depression, suggesting that targeting LHb in conjunction with RA treatments may be a promising strategy for RA patients comorbid with depression.

Hyperthemia (>50 °C) induced heating damage of nearby normal organs and inflammatory diseases are the main challenges for photothermal therapy (PTT) of cancers. To overcome this limitation, a redox-responsive biomodal tumor-targeted nanoplatform is synthesized, which can achieve multispectral optoacoustic tomography/X-ray computed tomography imaging-guided low-temperature photothermal-radio combined therapy (PTT RT). In this study, Bi2 Se3 hollow nanocubes (HNCs) are first fabricated based on a mild cation exchange way and Kirkendall effect and then modified with hyaluronic acid (HA) through redox-cleavable linkage (-s-s-), thus enabling the HNC to target cancer cells overexpressing CD-44 and control the cargo release profile. Finally, gambogic acid (GA), a type of heat-shock protein (HSP) inhibitor, which is vital to cells resisting heating-caused damage is loaded, into Bi2 Se3 HNC. Such HNC-s-s-HA/GA under a mild NIR laser irradiation can induce efficient cancer cell apoptosis, achieving PTT under relatively low temperature (≈43 °C) with remarkable cancer cell damage efficiency. Furthermore, enhanced radiotherapy (RT) can also be experienced without depth limitation based on RT sensitizer Bi2 Se3 HNC. This research designs a facile way to synthesize Bi2 Se3 HNC-s-s-HA/GA possessing theranostic functionality and cancer cells-specific GSH, but also shows a low-temperature PTT RT method to cure tumors in a minimally invasive and highly efficient way.

Objective: To evaluate the clinical characteristics of gastrointestinal Behcet's disease in a cohort of South China and compare the efficacy of different medications. Method:We retrospectively revised the medical record of a cohort of BD patients admitted to the first affiliated university hospital of Sun Yat-sen University between January 2005 and March 2017.Demographic information, gastrointestinal symptoms and extra-intestinal manifestations, laboratory findings, disease activity index (DAIBD), imaging characteristics and managements were documented.Results: Records of 1648 Behcet's disease cases were reviewed, of which, 187 cases were diagnosed of intestinal BD.Intestinal BD was more commonly found in male (73.3%) and male showed a significantly higher rate of gastrointestinal haemorrhage.Higher frequency of eye involvements and musculoskeletal involvements, less skin lesions were noted in the intestinal BD group.Abdominal pain and abdominal distension were the most common symptoms observed.Ileal/Ileocecal region was the most commonly affected under endoscopy.Mesenteric vessel lesions were not frequently detected but associated with poor prognosis.Most intestinal BD cases could be controlled with corticosteroid and immunosuppressors.CTX showed longer recurrence duration than AZA or MTX as maintenance therapy. Conclusion:Intestinal Behcet's diseases could be difficult to diagnosis and associated with severe complications.Male is more commonly involved and had higher rate of severe complications.Mesenteric vessel lesions were not frequently detected but associated with poor prognosis.Corticosteroids, immunosuppressants and TNF blockers were effective for most patients.As maintenance therapy, CTX was more effective than AZA or MTX.

Objective: To evaluate the tumor burden reducing efficacy and safety of transcatheter arterial embolization (TAE) combined with octreotide LAR on neuroendocrine tumor liver metastasis (NETLM). Methods: Twenty-nine NETLM patients treated in the First Affiliated Hospital of Sun Yat-sen University from October 2014 to August 2018 were retrospectively recruited, including 12 males and 17 females. The mean age was 25-69(50±11) years. All patients were histologically proved as well-differentiated NET liver metastasis. Seventeen patients underwent combined treatment of TAE plus octreotide LAR (combined group) and 12 patients treated with only octreotide LAR (control group). Response of hepatic lesions were assessed according to RECIST 1.1. Objective response rates (ORR) of two groups were compared and analyzed. Safety and tolerance to TAE were also evaluated. Results: There were 13 PR and 4 SD in combined group, but only 1 PR and 9 PD in the control group. The ORR between the two groups were significantly different (13/17 vs 1/12, P<0.01).The main complication post TAE was post embolization syndrome, including abdominal pain (12/17), vomiting (6/17), fever (4/17), elevated transaminase (8/17) and bilirubinemia (3/17). Tumor lysis syndrome was observed in one patient. Conclusion: Compared to administration of octreotide LAR, TAE combined with octreotide LAR can effectively reduce tumor burden in patients with NETLM. TAE is safe and well-tolerated.

SMYD3, a member that belongs to the SET and MYND-domain (SMYD) family, has also been proven to largely participate in gene transcription regulation and progression of several human cancers as a histone lysine methyltransferase. However, the role and significance of SMYD3 in both the clinic and progression of hepatocellular carcinoma (HCC) remain unclear. Herein, we find that SMYD3 is increased in cirrhotic livers, and strikingly upregulated in hepatocellular carcinoma (HCC) tissues and cell lines. Subsequent analyses suggest that high expression level of SMYD3 significantly correlates with the malignant characteristics of HCC, and predicts poor prognosis in patients. Our results show that overexpression of SMYD3 increases, while silencing of SMYD3 inhibits, cell proliferation, invasiveness and tumorigenicity both in vitro and in vivo. SMYD3 also promotes intrahepatic metastasis of HCC cells. For the mechanisms, we identify that SMYD3 bound to CDK2 and MMP2 promoter and increased H3K4me3 modification at the corresponding promoters to promote gene transcription. Importantly, pharmacological targeting of SMYD3 with BCI-121 inhibitor effectively repressed the tumorigenicity of HCC cells. Finally, our results show that gene locus amplification is a cause for SMYD3 overexpression in HCC. These findings not only uncover that SMYD3 overexpression promotes the tumorigenicity and intrahepatic metastasis of HCC cell via upregulation of CDK2 and MMP2, but also suggest SMYD3 could be a practical prognosis marker or therapeutic target against the disease.

To evaluate the efficacy and safety of intra-arterial chemotherapy (IAC) combined with intravesical chemotherapy (IC) in non-muscle invasive bladder cancer (NMIBC) and identify the risk factors for recurrence and progression. This is a retrospective cohort study of NMIBC patients in south China. Ninety-nine patients underwent IAC combined with transurethral resection of bladder tumor (TURBT) and IC, and 50 patients underwent TURBT plus IC without IAC. The 5-year outcomes of the two groups were compared. Cox regression was used to evaluate risk factors. Kaplan–Meier curves were used to assess the significant differences of recurrence-free survival and progression-free survival. At 5 years, IAC significantly reduced the recurrence of high-grade NMIBC, 54.5% (18/33) in the non-IAC group vs 30.5% (18/59) in the IAC group (p = 0.028). IAC significantly reduced the recurrence of high-risk NMIBC, 56.3% (18/32) in the non-IAC group vs 26.1% (18/69) in the IAC group (p = 0.007). IAC significantly reduced the recurrence of intermediate-risk NMIBC, 44.4% (8/18) in the non-IAC group vs 22.2% (6/27) in the IAC group (p = 0.030). Tumors numbering from 2 to 7 had the highest recurrence rate (18.1%, 27/149). In this aspect, there was a significantly lower recurrence rate in the IAC group (30.8%, 12/30) than in the non-IAC group (68.2%, 15/22) (p = 0.007). No significant difference was found in the progression rate between the two groups. Only two cases (2/99, 2.0%) in the IAC group showed progression. The results of univariate and multivariate analyses suggested that the number of tumors, grade and risk level were risk factors for recurrence. No difference was found with respect to gender, age, tumor diameter, and T category. In the Kaplan–Meier plot, recurrence-free survival was significantly associated with treatment strategies (p < 0.01). Recurrence-free survival was shorter in the non-IAC group (12.73 ± 7.56 months) than in the IAC group (17.88 ± 12.26 months). Combined IAC is a promising procedure to prevent recurrence and may be useful to suppress progression in NMIBC patients. The independent risk factors for the recurrence of NMIBC were multifocal tumors, grade and risk level. Intra-arterial chemotherapy is an effective and safe procedure and may be a promising choice in areas where BCG is not available or for patients who are intolerant to BCG.

Background Osteoarthritis is characterized by joint inflammation and cartilage degradation. Adipose derived stem cells (ADSCs), as a source of adult mesenchymal stem cells, display similar multiple-linage differentiating potentials to bone marrow MSCs, only are much more abundant, much easier to isolate and expand, have been suggested for suppressing inflammatory responses and repairing cartilage damage. Autophagy are known to be take part in the pathogenesis of OA. Aging related changes of chondrocytes were related to increased mammalian target of rapamycin (mTOR) signaling and defective autophagy (1). We aim to determine the effect of ADSC on autophagy and its underlying mechanism. Objectives To investigate the effect of ADSCs on autophagy in a rat osteoarthritis model and IL-1-induced chondrocytes, and to ascertain whether it regulates autophagy via PI3K/AKT/mTOR signaling. Methods ADSCs and chondrocytes were isolated from SD rats. Flow cytometry was performed for ADSC phenotypic characterization. ADSCs and chondrocytes coculture were established in the presence of IL-1β. A rat anterior cruciate ligament transection (ACLT) OA model were established. ADSCs or irrelevant cell lines of similar number were injected in the osteoarthritis-affected joints. Autophagic activation was determined by Western blotting for LC3-II, p62, MDC (monodansylcadaverine) staining and GFP-LC3 fluorescence microscopy. Autophagy inhibition was mediated by siRNA knockdown of ATG5. Relevant proteins in the PI3K/AKT/mTOR signaling pathway were detected by western blotting. IL-1β, IL-6, TNFα, IFN-γ, Col2, MMP-1, 3 and -13 were measured. Histology of the target joints were evaluated. Results Application of ADSCs resulted in downregulation of MMP13 and upregulation of Col2 in OA model cartilage and IL-1β induced chondrocytes. ADMSCs decreased pro-inflammatory cytokines IL-1β, IL-6, and TNF-α in rat OA and IL-1β-induced chondrocytes. Autophagy was inhibited in OA model and IL-1β induced chondrocytes. ADSCs increased cell viability and autophagy-related proteins levels in vitro and in vivo. In IL-1β induced chondrocytes with ATG5 knockdown by siRNA, the effect of ADSCs on autophagy activation and its function as suppression of IL-1β induced pro-inflammatory cytokines was undermined. Furthermore, ADSCs remarkably decreased the expressions of phosphorylated (p)-PI3K, p-AKT and p-mTOR in IL-1β induced chondrocytes. Conclusion ADSCs inhibited the progression of cartilage degeneration in a rat OA model and provide an effective approach to decrease the pro-inflammatory cytokines secretion. ADSCs’ anti-inflammatory effect was associated with cell autophagy and these roles of ADSCs may be associated with PI3K/AKT/mTOR signaling pathway. References [1] Alvarez-Garcia O, Olmer M, Akagi R, Akasaki Y, Fisch KM, Shen T, Su AI, Lotz MK. Suppression of REDD1 in osteoarthritis cartilage, a novel mechanism for dysregulated mTORsignaling and defective autophagy.Osteoarthritis Cartilage. 2016; 24(9):1639-47. Disclosure of Interests None declared

Budd-Chiari syndrome (BCS) is a rare but severe venous form of Behcet's disease (BD) that is caused by the obstruction of the venous outflow tract that transports blood from hepatic veins into the inferior vena cava. In countries where BD is prevalent, including the Middle East and Far East, BCS awareness is important. In the present study, two cases of BCS are presented in two male Chinese patients with BD. The clinical characteristics, treatment and outcomes were recorded and compared with previous studies, and the features of BD-BCS were summarized. The clinical characteristics of the two patients documented were similar. Each patient presented with insidious onset, abdominal symptoms and recurrent aphthous ulcers. Accurate diagnosis was delayed as other symptoms of BD were overlooked. Each patient responded well to TNF- inhibitor treatment in combination with cyclophosphamide (CYC). One patient with good compliance was removed from CYC and corticosteroid therapy. Unfortunately, the other patient with poor compliance faced a poor outcome. It was concluded that multiple vessel lesions in 2 sites are common in vasculo-BD and that misdiagnosis may occur if other symptoms of BD are not noticed. BD-BCS is associated with a high mortality rate, but appropriate treatment may result in a favorable outcome.

OBJECTIVES:To evaluate the efficacy of different tapering or discontinuation strategies of etanercept in a cohort of axial spondyloarthritis from South China. METHODS:We performed a retrospective cohort study. Axial SpA patients who achieved clinical remission for at least 6 months after receiving a standard dose of etanercept therapy were enrolled. Different tapering or discontinuation strategies were compared. RESULTS:Altogether, 258 cases were enrolled. No differences were found in baseline characteristics among the three groups. Significantly more patients on discontinuation group (19%) than tapering group (5.4%, p<0.001) relapsed as early as 6 months. Almost all of the patients (103/107, 96.3%) in taper 25% group and more than 80% (71/88, 80.7%) of the patients in taper 50% group maintained low disease activity (LDA) or clinical remission during the first year. At the end of the 2-year follow-up, the percentage of patients maintaining LDA or remission were 28.6% (discontinuation), 55.7% (taper 50%), 84.1% (taper 25%), respectively. Activity indexes were significantly lower in taper 25% group compared to the other two groups. Patients in discontinuation group and tapering 50% group, with longer SpA duration were more likely to relapse, and remission>12 months before discontinuation/tapering helped to reduce relapse. CONCLUSIONS:It is feasible to slowly increase the dosing interval and transit to the lowest effective dosing interval for some patients in remission/LDA. Prolonging the time under remission before tapering help to improve the outcome. Tapering 25% of the etanercept dose every 3 months may be a pragmatic approach for more cost-effective use of the drug.

We aim to explore the effect of adipose derived mesenchymal stem cells (ADMSCs) on a knee osteoarthritis rat model and analyze how ADMSCs affect chondrocyte apoptosis.A surgically induced rat knee osteoarthritis (OA) model was constructed. ADMSCs were engrafted into the right knee cavity. Hematoxylin and eosin (H&E), Masson, and Safranin O were used to compare the histopathology of synovial membrane and cartilage. Immunohistochemical (IHC) was used to measure MMP-13, Collagen 2 (Col-2), Caspase-3 (Cas-3), PARP, p62, LC3b, DDR-2, FGFR-1, Wnt, P-AKT/AKT, p-CAMKII/CAMKII, and p-Smad1/Smad1 expression in the articular cartilage. qPCR and Western blot analysis were used to detect mRNA and protein levels of markers in chondrocytes. TUNEL and Annexin-V were used to assess apoptosis.Histological analysis showed that ADMSCs alleviated the deterioration of cartilage and osteoarthritis. ADMSCs coculture increase the expression of Col2 and Sox-9, while down regulated MMP-13 in IL-1β stimulated chondrocytes. ADMSCs decreased proinflammatory cytokines IL-1β, IL-6, and TNF-α. ADMSCs enhanced the viability of IL-1β stimulated chondrocytes. ADMSC attenuated chondrocyte apoptosis. The pretreatment of 3-methyladenine (3-MA) reversed the reduction of Caspase-3 caused by ADMSCs, showing that the antiapoptotic effect was associated with autophagy inducing. ADMSCs significantly reduced the expression of FGFR-1, DDR-2, and Wnt in IL-1β stimulated chondrocytes. ADMSCs reduced the ratio of p-Smad1/Smad1 and p-CAMK II/CAMKII, and increased the ratio of p-AKT/AKT.ADMSCs treatment alleviate osteoarthritis in rat OA models. AMDSCs reduced the secretion of proinflammatory cytokines and protected against apoptosis through autophagy inducing. ADMSCs' function could be related to multiple signaling pathway.

Objective To evaluate the clinical efficacy of internal iliac arterial infusion chemotherapy in the treatment of non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT) and analyze the risk factors of the recurrence and progression of NMIBC.Methods The clinical and pathological data of 99 NMIBC patients who underwent internal iliac arterial infusion chemotherapy after TURBT were collected.The clinical efficacy was evaluated and the recurrence and progression of NMIBC were assessed.Results Among 99 enrolled NMIBC patients,91 cases were male and 8 female.The mean duration of follow-up was (29.1 ± 17.3) months.The overall recurrence rate was 23％ (23/99).The 1-year and 2-year recurrence rates were 8％ and 22％.The overall progression rate was 9％ (9/99).The 1-year and 2-year progression rates were 5％ and 9％.The recurrence rates for NMIBC patients with 1,2-7 and ＞7 tumors were 8％ (2/26),13％ (4/31) and 40％ (17/42),respectively (P =0.040).The recurrence rate for lowgrade NMIBC patients was 11％ (4/38),significantly lower compared with 31％ (19/61) for those with highgrade NMIBC (P =0.015).The progression rate for patients with Ta NMIBC was 3％ (2/60),significantly lower than 18％ (7/39) for their T1 NMIBC counter parts (P =0.040).Multivariate analysis demonstrated that the number and grade of tumors were the independent risk factors of postoperative recurrence in NMIBC patients.Conclusions A large quantity of tumors and high-grade tumors are the independent risk factors of postoperative recurrence in NMIBC patients undergoing internal iliac arterial infusion chemotherapy after TURBT.T1 tumor staging is the risk factor of progression of NMIBC.

Background Assisted reproductive technology has helped a large quantity of couples having trouble in natural pregnancy. Failure of in vitro fertilization-embryo transfer (IVF-ET) may be attributed to ANA and ds-DNA. ANA+/anti-dsDNA was related to low-quality embryos, low clinical pregnancy, and early miscarriage rate.1 Hydroxychloroquine (HCQ) is recommended preconceptionally and throughout pregnancy for patients with SLE, and was proved to benefit the patients with Antiphospholipid syndrome. For those women with positive ANA and ds-DNA, but haven’t any symptoms related to lupus or any other autoimmune diseases, the treatment for improving reproductive outcomes was controversial. In the present study, we retrospectively reviewed 156 patients with positive ANA and ds-DNA who underwent IVF-ET, compared the efficacy among different therapeutic strategies and observed side effects of the medication. Objectives To assess the efficacy, safety and tolerability of HCQ as preconceptionally and throughout pregnancy therapy in the treatment of IVF-ET patients with positive ANA and ds-DNA. Methods We retrospectively reviewed 156 patients in the treatment of IVF-ET with positive ANA and ds-DNA but without any symptoms in south China from January 2010 to December 2016 who received prednisone or prednisone +HCQ as preconceptionally and throughout pregnancy therapy. Prednisone was administrated at a dose of 7.5 mg/day. HCQ was administrated at a dose of 0.2 twice a day. Details of the IVF-ET outcomes and side effects were collected. Results Of the 156 patients, no significance of demographic variables and reproductive related parameters such as duration of infertility, basal sex hormone, total Gn dose, E2 level on the day of HCG initiation, and number of retrieved oocytes was found among prednisone group (65 cases) and prednisone +HCQ group (91 cases). Fertilisation rate, implantation rate and clinical pregnancy rate were significantly higher in prednisone +HCQ group than in prednisone group, 75.8% vs 60.0%, p=0.017, 29.7% vs 15.4%, p=0.032, and 62.6% vs 47.7%, p=0.028, respectively. Abortion rate was lower in prednisone +HCQ group, 7.0% vs 12.9%, but not significantly. Clinical pregnancy rate was not associated the titers of ANA or ds-DNA. Low C3 was correlated with failure of implantation. None of the cases on prednisone or prednisone plus HCQ had side effects affecting the treatment course. Conclusions Combination of prednisone and HCQ may be more effective than solo treatment of prednisone for patients underwent IVF-ET with positive ANA and ds-DNA who had no clinical symptoms of autoimmune diseases. Reference [1] Fan J, Zhong Y, Chen C. Impacts of Anti-dsDNA Antibody on In Vitro Fertilization-Embryo Transfer and Frozen-Thawed Embryo Transfer. J Immunol Res. 2017;2017:8596181. Acknowledgements Project supported by Guangdong Natural Science FoundationNo. 2016A030313217). Disclosure of Interest None declared

The aim of this study was to investigate the prevalence, severity, risk factors, and treatment outcomes of cyclophosphamide (CYC)-induced hemorrhagic cystitis (HC) in patients with rheumatic diseases.

Background Anti-TNF agents have deeply improved the therapeutic efficacy of spondyloarthritis (SpA)-related uveitis [1]. Despite the benefits of anti-TNF drugs, patients need to stay on this treatment for a long time. There has been a clear medical need to consider the long-term safety and increased drug costs. Unanswered question for physicians is whether TNF blockers can be reduced or even stopped in SpA-related uveitis, or how can it be reduced in patients have achieved remission or LDA. The current study aimed to investigate the effectiveness and safety of adalimumab tapering strategy in SpA-related uveitis. We tried to find a way in balancing the quality of the patients9 lives, the side effects and the cost-effectiveness. Objectives The aim of this study was to evaluate the effectiveness of tapering of adalimumab combined with MTX in patients with spondyloarthritis (SpA)-related uveitis. Methods We performed a retrospective analysis. SpA patients with uveitis admitted to a south China hospital were enrolled. Demographic information, clinical characteristics, laboratory findings, intraocular inflammation, visual acuity, and macular thickness were documented every 3 to 6 months. Results In 32 cases of SpA-related uveitis who achieved clinical remission for at least 6 months after receiving a standard dose of adalimumab in combination of MTX, adalimumab was tapered and MTX was continued. Dosing interval of adalimumab were spaced by 30% every 3 months up to complete stop. Twenty-six cases without MTX were analyzed for comparison. No significant difference of demographic characteristics and BASDAI, CRP, ESR was found between the two groups at the baseline. During the first 12 months of adalimumab tapering, the mean BASDAI remained stable in both groups. No recurrent uveitis was found in the group with combined MTX. In the group without combined MTX, 2 patients (2/26, 7.7%) presented increased anterior chamber inflammation and visual acuity. At the end of 24 months, mean BASDAI, CRP and ESR remained low in both groups. Two cases (2/32, 6.3%) in the group of combined MTX were documented increased BASDAI higher than 4, but no recurrent uveitis was observed. Altogether 5 cases (5/32, 15.6%) in the group of combined MTX had recurrent uveitis, in which 4 cases (4/5, 80%) initiated adalimumab tapering at 6 months9 remission. In comparison, 8 cases (8/26, 30.8%, p<0.001) in the group without combined MTX had recurrent uveitis, in which 6 cases initiated adalimumab tapering at 6 months9 remission and 2 cases initiated adalimumab tapering at 9–12 months9 remission. No patients had recurrent uveitis at 12 months9 remission or longer in both groups. Adalimumab plus MTX were well tolerated in all patients. Conclusions For maintaining remission of SpA-related uveitis, adalimumab tapering can be effective when combined with MTX. Initiation of the tapering after 12 months9 remission largely lower the rate of recurrence. References Jaffe GJ, Dick AD, Brézin AP, et al. Adalimumab in Patients with Active Noninfectious Uveitis. N Engl J Med. 2016 Sep 8; 375(10):932–43. Disclosure of Interest None declared