BackgroundEarly arthritis is an inflammatory disease with the potential to progress to persistent arthritis, such as established Rheumatoid Arthritis (RA) or other articular disease, to resolve spontaneously or remain undifferentiated for indefinite periods of time.ObjectivesTo identify predictors of persistent RA after 12 months follow up in the Argentinean early arthritis clinic (CONAART).MethodsWe conducted an observational, prospective longitudinal study, including patients with early arthritis (at least 1 swollen joint with <2 years of evolution) who had at least one year of follow-up.Sociodemographic and clinical data and characteristics of the disease were recorded at baseline, at 3, 6 and 12 months. After 1 year of follow-up, each patient was classified according to diagnosis: self-limited arthritis, persistent non-erosive arthritis, or persistent erosive arthritis.The association between the different predictors of diagnosis at 12 months was evaluated using multiple logistic regression, adjusted by potential confounders. Rheumatoid Factor (RF) and Anti Citrullinated Peptide Antibodies (ACPA) were included in separate models in order to avoid multicollinearity. A value of p<0.05 was considered significant.ResultsWe included 839 patients, 83% females, mean age of 57±14 years and mean disease duration of 8.2±6.2 months; 67.5% were rheumatoid factor positive and 59% ACPA positive. Disease characteristics at baseline were DAS28 5.1±1.4, swollen joints 6±5, erythrocyte sedimentation rate (ESR) 34±25 mm/h, C Reactive Protein (CRP) 4±6 and Health Assessment Questionnaire-Argentinean (HAQ-A) 1.2±0.8.After 12 months follow up, 11% of the patients were diagnosed as self-limited disease, whereas 89% were diagnosed as persistent disease. For the persistent disease, 34% presented radiograph erosions and therefore were catalogued as persistent erosive disease.The seropositivity for both, RF and ACPA, together with baseline DAS28, were the variables independently associated with the development of persistent disease at 12 months. [Model 1a: RF OR 2.33 (95% CI 1.44, 3.78) and DAS28 1.27 (1.06, 1.52); Model 2a: ACPA 2.61 (1.38, 4.93) and DAS28 1.59 (1.24, 2.04)]. (Table 1).Table 1.Predictors of Persistent Rheumatoid Arthritis at 12 monthsOutcomesPersistent RAPersistent RAPersistent RAPersistent RAOR (95 IC)OR (95 IC)OR (95 IC)OR (95 IC)Model 1aModel 1bModel 2aModel 2bn708708507507Age (years)0.99 (0.98, 1.01)0.99 (0.98, 1.01)0.99 (0.97, 1.01)0.99 (0.97, 1.01)Female gender1.06 (0.57, 2.00)1.06 (0.56, 1.99)0.72 (0.30, 1.71)0.72 (0.30, 1.70)RF positive2.33 (1.44, 3.78)***2.45 (1.52, 3.98)***--ACPA positive--2.61 (1.38, 4.93)**2.63 (1.39, 4.98)**DAS28 at baseline1.27 (1.06, 1.52)**1.59 (1.24, 2.04)***Categorical DAS28 MDA (vs LDA)-1.81 (0.85, 3.86)^-2.86 (1.68, 6.99)* HDA (vs LDA)-2.83 (1.30, 6.15)^-6.39 (2.42, 16.82)***^ p<0.1, * p<0.05, ** p<0.01, *** p<0.001RF, Rheumatoid Factor; ACPA, Anti Citrullinates Protein Antigen; DAS28, Disease activity Score-28; LDA, low disease activity; MDA, moderate disease activity; HDA, high disease activity.In the patient prediction model, it can be observed that a patient with female gender, ACPA negative, and a low activity at baseline (DAS28 <3.1) presents a 62.3% of likelihood of developing persistent arthritis after 12 months, while a male patient, ACPA positive, with a high baseline activity level, the probability of having persistent disease rises to 97.5%. (Figure 1)Figure 1.Matrix prediction model. Probability of diagnosis of Persistent Rheumatoid Arthritis after 12 months of follow-up. Colors represents predictive probability of achieving the outcome as follow: grey: 0-69.9%; blue: 70.0-89.9%; purple: 90.0-100%.DAS28, Disease Activity Score 28; LDA, low disease activity; MDA, Moderate Disease Activity; HDA, High Disease Activity.ConclusionPredictors of persistent arthritis after 12 months of follow up since AT diagnosis were RF and ACPA seropositivity and higher baseline disease activity level.Disclosure of InterestsNone declared.

ObjectivesTo evaluate work capacity and quality of life in patients with early Psoriatic Arthritis (PsA).MethodsMulti-center study in which patients with recent onset of PsA (disease duration <3 years) who met the CASPAR criteria established by the Early Spondyloarthritis Committee (CONEART) were enrolled. Work loss and lost workdays within six months prior to the baseline visit attributable to their baseline condition were evaluated, as well as quality of life, measured by PsAQol. Statistical analysis: descriptive statistics, Spearman9s correlation, multiple linear regression model.Results108 patients with a PsA diagnosis were enrolled. 53% (57/108) were male, of a mean age of 48.4 (SD 12.5). The mean PsA disease duration was 17.6 (SD 9.8) months. 4/60 patients (6.6%) were positive for HLA-B27. BASDAI 4.81±2.66; BASFI 3.75±2.70; PsAQoL 7.24±6.44; HAQ-A 0.72±0.61, physician global activity assessment (by Visual Numeric Scale, VNS) 3.76±2.33, and pain assessment (VNS) 5.22±2.98. The average days lost due to the condition within the past 6 months was 8.6 (SD 32.1), it was significantly associated with the presence of enthesitis, number of swollen joints, worse BASDAI, BASFI, lower level of education, and higher pain and physician global activity assessment (p<0.0001). Five patients lost their job due to PsA. 12% of the patients had a disability certificate and the possession of one, according to the logistic regression model, was associated with a longer PsA disease duration (OR 1.09, p=0.02). A poorer quality of life was significantly correlated to the physician assessment of disease activity (p<0.001) and pain (p<0.01) using a linear regression model.ConclusionsIn this cohort of patients with early PsA, the deterioration of work capacity expressed in lost workdays was associated with disease activity parameters and functional disability. The physician global activity assessment and pain were the main factors associated with the impact on patient9s quality of life. Having a disability certificate was associated with longer disease duration. Although this is an early cohort of PsA patients, a worsening in quality of life and work disability was observed.Disclosure of InterestF. Colombres: None declared, H. Berman: None declared, A. Spindler: None declared, W. Spindler: None declared, J. Maldonado Cocco Grant/research support from: Pfizer Argentina, M. Orozco: None declared, E. Schneeberger Grant/research support from: Pfizer Argentina, A. Ortiz: None declared, S. Paira Grant/research support from: Pfizer Argentina, M. Zalazar: None declared, O. Rillo Grant/research support from: Pfizer Argentina, D. Baenas: None declared, A. Alvarellos Grant/research support from: Pfizer Argentina, T. Alvarellos: None declared, M. Garcia Grant/research support from: Pfizer Argentina, A. Salas: None declared, V. Duarte: None declared, F. Romanini Grant/research support from: Pfizer Argentina, L. Ferreyra Garrott: None declared, E. Soriano Grant/research support from: Pfizer Argentina, L. Galindo: None declared, G. Castelli: None declared, C. Borlenghi: None declared, A. Berman Grant/research support from: Pfizer Argentina

Methods: We included a cohort of patients with diagnosis of early RA of less than 2 years of disease duration who not respond to MTX monotherapy, according to medical judgment, and added step-up combination with LEF. Data were collected every 3 months, including sociodemographic characteristics, functional status, disease activity and treatment. The primary outcome was the time to remission with the combined therapy, defined according to disease activity index of 28 joints (DAS28). Combination treatment failure was defined as not achieving remission. Time of outcome was assessed from date of the start of MTX plus LEF combination to date of remission or last follow-up. The Kaplan-Meier product limit method was used to estimate the probability of each outcome. Results: A total of 106 patients were included. The median disease duration was 4 (IQR 2-8) months. Median followup was 34 ± 18 months (300 patients-year). Mean age was 50 ± 12 years and 83% were female. At the time of LEF addition, 95 (90%) of patients were not in remission. During follow-up, 47 (50%) achieved clinical remission at a median time of 8 months. The rest of the patients failed to achieve remission. The overall probability of remission per patients-months of follow-up was 0.49. Twenty seven out of 47 patients (58%) were still in remission at the last follow up visit (median follow-up after first remission=19 months). Conclusion: In early RA patients with non-response to MTX monotherapy, the addition of LEF allowed to achieve remission in 50% of patients, at a median time of 8 months. Six out of ten of these patients were still in remission after almost 2 years of follow-up.

Background Blocking TNF alpha (TNFα) with monoclonal antibodies (mAbs) has been successful in the treatment of rheumatoid arthritis. However primary and secondary resistances are frequent and impose treatment changes. Active immunization with a TNF-Kinoid that safely induces self polyclonal anti-TNFα antibodies (Abs) could be an alternative to anti-TNFα mAbs Objectives We evaluated the immunogenicity and safety of TNF-K in patients with rheumatoid arthritis and secondary resistance to TNF blockers. Methods TNFα-Kinoid (TNF-K, Neovacs SA, Paris, France) is an immunotherapeutic composed of recombinant human TNFα conjugated to KLH, inactivated and adjuvanted with ISA-51 emulsion. 40 patients with active rheumatoid arthritis (DAS28≥3.2) with history of positive clinical response to TNF-blockers followed by secondary failure (35% IFX,30% ADA, 42.5% ETA) were enrolled in a double-blind, placebo-controlled, phase 2 study to evaluate three different intramuscular doses of TNF-K (90, 180, 360 mcg) and two immunization schedules (D0 and 28 or D0, 7 and 28). Immune responses were evaluated through titration of anti-TNFα and anti-KLH Abs. Clinical response was evaluated by the ACR and EULAR core set response. Results No related serious adverse event has been reported. Few minor transient local and systemic reactions have been recorded following immunization. Anti-TNFα Abs were induced in 50%, 75% and 91% of patients at 90 mcg, 180 mcg and 360 mcg, respectively. 100% of patients with three injections of 180 or 360 mcg had immunogenic response against 67% in two injections groups. Among the 21 patients who developed anti-TNF Abs, 48% present a moderate to good response according to EULAR score as opposed to only 31% of the 16 patients without Abs. A mean decrease of -14% of the C reactive protein level is measured in patients with Abs while in patients without Abs, the mean CRP level increased by 5%The mean decrease of the DAS28 score is -0.8 points in patients with Abs while it is only -0.5 in patients without Abs. Conclusions Active immunization with TNFα kinoid to induce a polyclonal, self-anti-TNFα antibody response is safe and immunogenic. A clinical and biological response were observed in some patients included in this preliminary phase 2 study and further studies are needed to confirm this new approach in RA. Disclosure of Interest P. Durez: None Declared, P. Miranda: None Declared, A. Toncheva: None Declared, A. Berman: None Declared, O. L. Rillo: None Declared, Y. Boutsen: None Declared, T. Kehler: None Declared, E. Mociran: None Declared, L. Soto Saez: None Declared, B. Fautrel: None Declared, X. Mariette: None Declared, P. Sokalov: None Declared, E. Lucero: None Declared, T. Vlak: None Declared, S. Grazio: None Declared, K. Mastrovic: None Declared, R. Chirieac: None Declared, G. Grouard-Vogel Employee of: Neovacs, O. Dhellin Employee of: Neovacs, S. Ouary Employee of: Neovacs, B. Fanget Employee of: Neovacs, P. Vandepapelière Employee of: Neovacs, M.-C. Boissier Consultant for: Neovacs

Background Rheumatoid arthritis (RA) is known to have a variable course resulting in a wide range of outcomes, varying from a mild disease causing hardly any impairment to severe disease leading to extensive disability and radiological damage1,2. Objectives The aim of the present study was to identify predictive factors for unfavorable outcomes in early rheumatoid arthritis patients. Methods The 1-year outcome of RA patients from a prospective inception cohort (CONAART-Argentine Consortium for Early Arthritis) was assessed. We defined the following 3 criteria for unfavorable outcomes: a clinical course with persistent moderate-high disease activity during the last 6 months (DAS28 average ≥ 3.2, or an increase > 1.2 compared to baseline, or at least one DAS28 >5.1), a disability worsening and a radiological damage increasing (HAQ deterioration within 1 year of ≥ 0.5 points and Simple Erosion Narrowing Score (SENS)- deterioration within 1 year of ≥ 1 points, respectively). Two groups of patients (unfavorable outcome or not unfavorable outcome), were identified for each of the 3 outcome dimensions. Significance of the difference between groups was tested using a Student's t-test, a Mann–Whitney U test, or a chi-square test where appropriate. All baseline parameters (demographic and socioeconomic parameters; comorbidities; disease characteristics; laboratory measures and radiographic measures) for both patient groups were analyzed. To calculate which baseline parameters predict outcome several logistic regression models were constructed. Results A total of 237 patients were included; 200 (84.4%) were women; 73% rheumatoid factor positive and 71% APCA positive. The mean age was 49 years (SD 12) and the median symptoms duration was 7 months (RIQ 3-12). After one year of follow-up, 141 (59.5%) patients had persistent moderate-high disease activity, 19 (8%) HAQ deterioration and 57 (24.1%) SENS worsening. The prognostic factors for persistent moderate-high disease activity were: medical history of anxiety or depression (OR 3.7; p 0.016), female gender (OR 3.1; p 0.003), and DAS28 (OR 1.3 p 0.005). Among all the factors we found that patients with monoarthritis at baseline had more probability of HAQ deterioration (OR 8.2; p 0.03) and greater values of DAS28 reduced it (OR 0.6 p 0.007). There were not baseline variables associated with radiographic progression. Conclusions Our study showed that in short-term follow up of early RA patients, different outcomes could be predicted using widely available baseline parameters. References Arthritis Rheum. 2002;47:383-90. Arthritis Res Ther. 2008;10:R106. Disclosure of Interest L. Casalla Grant/research support from: Pfizer Argentina, R. Chaparro del Moral : None Declared, O. Rillo : None Declared, M. Benegas: None Declared, F. Dal Pra: None Declared, H. Maldonado Ficco: None Declared, G. Citera: None Declared, A. Catalan Pellet: None Declared, A. Berman: None Declared, M. Haye Salina: None Declared, A. Alvarez: None Declared, F. Caeiro: None Declared, J. Marcos: None Declared, J. C. Marcos: None Declared, L. Catoggio: None Declared, E. Soriano: None Declared, F. Ceccato: None Declared, S. Paira: None Declared, M. O. Leal: None Declared, A. Quinteros: None Declared, G. Salvatierra: None Declared, M. Crespo: None Declared

The objective was to determine the prevalence of the metabolic syndrome (MS) in patients with systemic lupus erythematosus (SLE) in Argentina, to assess the factors associated to it, and to compare the results with a control group with non-inflammatory disorders. The study included 147 patients with SLE and 119 controls. MS was defined according to criteria by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) Scientific Statement. Demographic characteristics, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) were assessed as well as administration, maximum dose and cumulative dose of prednisone and hydroxychloroquine (HCQ). MS prevalence was 28.6% (CI 95%: 21.4–36.6) in patients with SLE and 16% in controls ( P = 0.0019). Patients with SLE presented higher arterial hypertension frequency compared with controls (43 vs 25%, P = 0.007). When comparing lupus patients with MS ( n = 41) and without MS ( n = 106), no significant differences were observed regarding duration of the disease, SLEDAI or cumulative prednisone dose. Cumulative damage was associated independently with MS (OR 1.98; P = 0.021), whereas HCQ use was found to be protective (OR 0.13; P = 0.015). Patients with lupus presented higher MS prevalence than controls with non-inflammatory disorders, and occurrence of arterial hypertension was also higher. MS was associated with cumulative damage; the use of HCQ showed to be protective against presence of MS.

Lors de la « Session générale » de l’ARHP, un épidémiologiste parle des douleurs du pied. Marian T. Hannan, DSc,MPH, is a senior scientist at the Institute for Aging Research at Hebrew Senior Life and an associate professor of Medicine at Harvard Medical School, a dit : « Despite the fact that our feet connect us to the world below, there’s not a lot of attention paid to feet compared to other joints ». Elle a présenté la communication : « Tip–Toeing Around Arthritis and Foot Pain: Current Musculoskeletal Research in Feet ».

s: XIVth Congress of the Pan-American League of Associations for Rheumatology: CATEGORY: RA: Clinical

s: XIVth Congress of the Pan-American League of Associations for Rheumatology: CATEGORY: RA: Clinical

A 46-year-old woman with systemic lupus erythematosus(SLE) and concomitant severe pulmonary hypertension (PH) is described. Other secondary causes of PH including thromboembolism, phospholipid syndrome, valvular disease and interstitial pulmonary involvement were ruled out. Owing to her lack of clinical response to conventional therapy, sildenafil was begun at increasing doses up to 400 mg daily. Both clinical and hemodynamic improvement ensued. This appears to be the first clinical report of the use of sildenafil in SLE followed by resolution of severe PH.

OBJECTIVE:To analyze the factors associated with mortality, survival and causes of death in patients with systemic lupus erythematosus (SLE) in Argentina.PATIENTS AND METHOD:A series of 366 patients with SLE (45 men and 321 women), mean age 29 y (range 11-70 y) and mean disease duration 6 y, was evaluated from 1990 to 1998. A total of 57 clinical, serological and therapeutic variables were studied.RESULTS:Five- and 10-year survival was 91% and 85% respectively. Forty four patients died (12%): 54% due to sepsis and 32% due to active SLE. Mortality risk factors included heart involvement CRR 3.82), hyperlipidemia (RR 2.72), renal damage (RR 2. 62), infections (RR 2.44), lung disease (RR 2.20) and myositis (RR 2. 07). High-dose prednisone (RR 3.4) or cyclophosphamide (RR 9.19) treatments increased the risk of sepsis (P=0.003) as a cause of death. However, corticosteroids, antimalarial agents and accumulated cyclophosphamide doses proved to be protective factors in overall mortality figures (RR <1).CONCLUSIONS:The main risk factors of death in SLE were heart involvement, hyperlipidemia and renal damage. Treatment with steroids, antimalarial agents and cyclophosphamide improved survival. High-dose corticosteroids and cyclophosphamide were associated with sepsis as a cause of death.