Informal care might have both positive and negative impact on caregiver’s life. Negative effects can cause an additional burden to caregivers suffering from musculoskeletal diseases. We aimed to assess musculoskeletal health of both informal caregivers and recipients, as well as the share of formal care. An online cross-sectional online survey was performed in 2020 involving a sample representative for the Hungarian adult population [N=2004; women: 53.1%; age (mean): 48.3, SD=16.6 years]. Respondents who received formal or informal care due to musculoskeletal problems or provided informal care were identified with self-administered survey methods. Socio-demographic characteristics, mobility (EQ-5D-5L) and physical functioning (HAQ-DI) were measured. Descriptive statistical methods were applied. Differencies between subgroups were analyzed with Chi-square, Mann-Whitney U and Kruskal-Wallis tests. Altogether 238 respondents [11.9%; women: 63.9%; age: mean 50.8, SD 15.2 years] had been providing informal care for >2 weeks, the median care time was 7 hours/week. In the last 3 months 113 respondents [5.6%; women: 61.9%; age: mean 58.0, SD: 11.7] received informal care and 33 [1.6%; women: 39.4%; age: mean 54.6, SD: 15.9] received formal care due to musculoskeletal problems. Need for informal care were reported in further 35 cases [1.7%; women: 45.7%; age: mean 55.4, SD: 14.2]. EQ-5D-5L and HAQ-DI scores were significantly worse among informal caregivers (median 0.887 and 0.250, respectively) and care recipients (median 0.664 and 1.000, respectively) compared to others (median 0.957 and 0.000, respectively). On the Mobility domain of EQ-5D-5L, 52.5% of informal caregivers and 88.5% of informal care recipients reported walking problems. A substantional proportion of informal caregivers live with musculoskeletal health problems. More people receive informal than formal care due to musculoskeletal disorders. These results provide basic input to identify patient groups affected by informal care and to develop social and healthcare strategies aiming to support informal caregivers.

We aimed to assess MSK problems in the Hungarian general population, to map healthcare service utilisations due to MSK health problems and to identify barriers of access. An online cross-sectional survey was carried out involving a normative sample of the Hungarian adult population [N=2004; women: 53.1%; age: mean 48.3, SD=16.6 years] in 2020. Socio-demographic characteristics, general (Minimum European Health Modul, EQ-5D-5L index) and MSK health state (EQ-5D-5L Mobility dimension, MSK related questions from the European Health Interview Survey), as well as physical functioning (HAQ-DI) were assessed. Need for and utilisation of healthcare services were recorded. Descriptive statistical methods were applied, differencies in socio-demographic characteristics and health state indicators between subgroups were analized with Chi-square, Mann-Whitney U and Kruskal-Wallis tests. 750 (37.4%) respondents indicated walking problems on the EQ-5D-5L, 147 (7.3%) had >1 HAQ-DI score. Difficulties in walking 500 meters and walking on 12 steps have been reported in 459 (23.1%) and 585 (29.4%) cases, respectively. Due to musculoskeletal health problems 147 (7.3 %) patients were admitted to hospital in the past 12 months. Referrals to specialists and general practitioner visits in the past three months were reported by 234 (11.7%) and 231 (11.5%) participants, respectively. Respondents who used either of these services were significantly older, had worse general health state, functional ability and had significantly more chronic health problems and disabilities compared to those who did not take any of these healthcare interventions. Important barriers to healthcare were financial problems (N=131; 6.5%), transportation (N=79; 3.9%), taking care of others (N=61; 3.0%) and the lack of support (N=35; 1.7%). The prevalence of musculoskeletal health problems is significant in the general population. Patients who encounter barriers to healthcare services need particular attention. Results of our study provide substantial information for organizing specialised services and planning health policy strategies.

The Health Assessment Questionnaire Disability Index (HAQ-DI) was developed to measure physical functioning. The aim of this study was to assess the physical functional status of the adult population with the HAQ-DI questionnaire and to establish population norms in Hungary. A cross-sectional computer-assisted personal interview survey was conducted in Hungary (year 2019), involving a sample of the adults (18+) representative for the general population. Demographic characteristics, physical functional status HAQ-DI, health status (EQ-5D-3L, EQ-5D-5L) and well-being (ICECAP-A in age group 18-64, ICECAP-O in age group 65+) were measured. Descriptive statistical analyzes were performed, differences between subgroups were examined by ANOVA test, and Pearson correlations between variables were performed. The research was supported by the Higher Education Institutional Excellence Program, within the framework of the ‘Financial and Retail Services' thematic program of the Corvinus University of Budapest. The average (SD) age of the participants (N=2,021; female 50.1%) was 48.7 (17.9) years and the HAQ-DI score was 0.138 (0.390). Altogether 19.6% of the respondents reported any problem on the HAQ-DI, the most problems were found in the ‘Activities’ domain (13.6%), the least in the ‘Eating’ (5.6%) and ‘Grip’ (5.8%) domains. HAQ-DI index score was significantly (p=0.000) higher in subgroups with older age, lower educational and income level, as well as among participants who were unemployed, living alone and in worse health status. Correlations were significant and moderate between HAQ-DI index and age (r=0.417), EQ VAS (r=-0.496), WHO-5 (r=-0.420), ICECAP-A (r=-0.351) and ICECAP-O (r=-0.509) and strong between the HAQ-DI and the EQ-5D-3L and EQ-5D-5L index scores (r=-0.685 and -0.747, respectively). On-fifth of the Hungarian adult general population reports limitation(s) in physical functioning. These limitations increase with age but not in a linear manner. Our HAQ-DI results can be used as reference scores in future clinical and epidemiological studies.

Background:Approximately 30% of rheumatoid arthritis (RA) patients fail to respond to first biological therapy, thus treatment selection of biologic therapy for patients with RA is of high importance. The lack of biomarkers to predict specific biological treatment response, in the case of non-responder (NR) patients leads to unnecessary exposure, delay of adequate therapy, progression of the disease and therapy cost increase. Predicting the patient’s responsiveness to the first biological therapy is still an unmet need in the clinical setting. Predictive in vitro testing would have a significant effect on the administration of biological therapy, on the real life implementation of cost effective personalized therapy.Objectives:The purpose of this in vitro diagnostic medical device study was to demonstrate that particular gene expression profiles as genomic biomarkers (i.e. the IVD medical device) predict therapeutic response to infliximab, discriminate between responders and non-responders to infliximab treatment. Responders were defined if they reached DAS target value DAS28≤3.2 at 6 month (M6).Methods:110 bionaive patients were enrolled with moderate-high activity RA (DAS28-CRP >3.2), who have responded inadequately to DMARDs (including methotrexate), after they have been assigned to infliximab treatment. All patients received commercially available infliximab, procured according to SmPC, local guidelines and regulations in this non-interventional clinical study. The clinical response was evaluated according to the change from baseline in disease activity at M6. Clinical characteristics (RA duration, smoke, steroid treatment, etc.) and serological parameters (RF, ACPA, aCVM) were collected. A 3rdvisit scheduled around week 22 (M6) and change of DAS28-CRP value from the baseline has been evaluated. Gene expression profiling was performed from blood samples taken at month 0 (M0); - just before the first infliximab infusion. Global gene expression profiling was performed to identify differentially expressing genes using RNA sequencing. The set of differentially expressing genes were further reduced with a combination of machine learning modelling and various feature elimination methods. The expression of the reduced gene set was confirmed and further analysed using reverse-transcription and quantitative real-time PCR.Results:A total of 250 genes were identified by a combination of differential gene expression analyses, feature elimination techniques and various machine learning modelling methods of which 44 genes showed significant differences between NR and good responder groups. Preliminary interim analysis identified associations between gene expression and clinical response/ non-response to infliximab therapy.Table.Three models containing gene expression + clinical data sets illustrates some statistical characteristicsModell building_IDAccuracySensitivitySpecificityModell VerificationAccuracySensitivitySpecificity00232100.00100.00100.00002328888.8987.5000249 98.82 96.55100.00002498477.7887.5000270 98.82 96.55100.00002708877.7893.75Conclusion:Our preliminary analysis shows that this set of genes and selected clinical parameters are predictive markers for infliximab specific response in RA patients. Ongoing work involves the clinical validation of these results in an independent patient cohort (n=60). This approach provides the opportunity to develop an in vitro diagnostic test method for the prediction of infliximab treatment responsiveness in bionaive rheumatod arthritis patients, hence to personalize infliximab therapy for these patients.Disclosure of Interests:Emese Kiss Consultant of: EK has received consultancy fees from Egis., Gyula Poór Consultant of: GyP has received consultancy fees from Egis and he was the coordinating investigator in this study, Gábor Zahuczky Grant/research support from: Egis, Katalin Tauberné Jakab Employee of: Egis., Miklós Sebeszta Employee of: Egis., Tamás Ponyi Employee of: Egis., Zsolt Holló Employee of: Egis.

OBJECTIVESUntil now, glucocorticoids (GCs) with their anti-inflammatory and immune suppressive effects are one of the most effective agents in therapy of several autoimmune disorders including rheumatoid arthritis (RA). Glucocorticoid receptor (GR) polymorphisms may result in variable sensitivity to glucocorticoids playing an important role in the development and control of symptoms in RA. We aimed to test whether the functional polymorphisms of the GR encoding gene (NR3C1) are associated with susceptibility to RA and with various clinical signs and symptoms.METHODS146 patients were enrolled at the National Institute of Reumatology. Clinical diagnosis was based on the criteria of the American College of Rheumatism (ACR) 2010. Complex clinical, routine laboratory and immunlaboratory evaluations were performed. For genotyping of the GR polymorphisms N363S (rs6195), BclI (rs41423247) and 9β (rs6198) peripheral blood DNA was used, extracted with commercially available reagents. Genotyping was performed with routine molecular biological methods. Genetic data were compared to those obtained in a healthy control group (n=160) using Chi square or Fisher tests. Associations between GR genotypes and clinical and immunological parameters were determined with ANOVA.RESULTSThe main finding of the present study is the lower frequency of the BclI in RA patients. Furthermore, regarding the laboratory and immunoserological parameters, the level of anti-DNA antibody was significantly higher in homozygous BclI carriers compared to heterozygous carriers, irrespective of the anti-TNF-alpha therapy.CONCLUSIONSOur results reveal that although GR polymorphisms are not key players in development or clinical course of RA, they might affect glucocorticoid action and, together with other endogenous and exogenous factors, interfere with the pathomechanism of RA. Our results reveal some possible factors (including BclI polymorphism), and therefore contribute to elucidate the implication of the combination of GR functional variants.

The main objective of the study was to categorise trajectories of disease activity measured by DAS28 score of biologic DMARD-naïve (bDMARD) rheumatoid arthritis (RA) patients. The secondary objective was to analyse whether these groups differ in demographic, disease-, treatment-related and cost variables. The retrospective analysis used patient-level healthcare utilization data from the National Health Insurance Fund of Hungary. The study period spanned five years from 01.01.2012 to 12.31.2016. The study population included those RA patients, who started their first bDMARD treatment during the study period, had at least two years of follow-up and had DAS28 measurements in every three month. The identification of different trajectory groups based on DAS28 measurements using longitudinal cluster method. The following five groups were separated by the clustering algorithm: initial high DAS28 improving slowly to moderate DAS28, initial high DAS28 improving slowly to low DAS28, initial high DAS28 improving rapidly to moderate DAS28, initial high DAS28 improving rapidly to low DAS28 and initial high DAS28 improving rapidly to remission. The groups were similar in age, gender and in the average time elapsed between diagnosis and the first bDMARD therapy. A significant difference was found between the groups in persistence of the first bDMARD therapy and in the proportion of patients who reached low disease activity and remission in the first half year. There was a notable difference in the burden of disease, and in the proportion of patients using combination therapies. Distinct disease trajectory groups exist in RA, and there is association between these groups and various patient- and treatment-related variables.

Recurrent thrombotic events occur in 20% of patients with APS despite of adequate antithrombotic therapy. As phospholipid-cofactor antibodies are key elements of pathophysiology, B cell depleting rituximab is a rational therapeutic approach. Aims were to identify and characterise APS patients receiving rituximab. All together 179 (60 primary, 119 lupus-associated) APS patients were found in our database of whom 15 (8.4%) were treated with RTX. As younger and male patients dominated in RTX +group, 15 from RTX naive patients were matched regarding age and gender for a case control study. First symptoms appeared at the age of 30 in both groups. Patients were followed for 4 and 7 years, the diagnosis delayed 4 and 1 year in RTX +and RTX- groups, respectively. This 3 year difference might contribute to higher disease severity. Primary APS (47% vs 32%), cerebrovascular events (13 vs 2), valvular heart disease (5 vs 2), and high risk triple aPL positivity (13 vs 5) were more prevalent in RTX +group. All 4 deep venous thrombosis cases in the RTX +group were complicated with pulmonary embolism in comparison with 1 PE within 6 RTX- DVT patients. Raynaud syndrome resulted in digital ulcer more frequently in RTX +than in RTX- group (4/4 vs 1/6). Antimalarials were given to 3 and 10, cumarin or NOAC were iniciated in 15 and 5 patients in the RTX +and RTX- groups, respectively. Rituximab was started 2 (0.5–6) years after diagnosis. Within 10 (3–60) moths follow-up on RTX there were no incident thrombotic events. Two thirds of patients could stop steroid. RTX was stopped in 6 cases: 3 due to remission (of whom 2 relapsed), 1 LFU, and 2 adverse events (1 longstanding B cell depletion, 1 peroneus paresis). Other AEs were 1 mild infusion reaction, 1 leukopenia, 1 UTI. As summarised, delay in APS diagnosis and male gender were associated with more severe disease and the need for rituximab. Antimalarials and associating lupus were identified as markers of more favourable disease outcome. In patients with recurrent thrombotic events despite of adequate anticoagulant therapy, RTX can be a rational and effective choice with favourable safety profile.

Background Whilst Juvenile Idiopathic Arthritis (JIA) is one of the most common chronic diseases amongst children, the impact of physical therapy on affected children’s life-quality and the importance of an appropriate and regular physical activity get less attention than they ought to. In addition, there are no such studies about the role of parents’ awareness in connexion with the regular physical activity for children with JIA available yet. Objectives The purpose of the survey was to evaluate the awareness of parents in connexion with the Juvenile Idiopathic Arthritis’ diagnose, its treatment options, the importance of regular physical activity and how it affects children’s life-quality. Everyday experiences say that children with JIA take part in less physical activities than their healthy mates do. Our aim was to detect how important regular physical activity is for parents. Methods This is a descriptive analysis of our self-compiled questionnaire which has 41 questions. It is being filled in both online and in paper forms since the February of 2017 in the National Institute of Rheumatology and Physiotherapy on the Department of Clinical Immunology, Adults’ and Children’s Rheumatology. Participants of the study are parents whose child has the diagnose of Juvenile Idiopathic Arthritis and ages between 2–18. Parents whose child has not differentiated diagnose or is under 2 years are excluded. Results 48 answers met the criteria, 6 answer sheets were excluded. In case the children’s condition get worse, 20,8% of parents marked wrong parental measures. All parents acknowledge the importance of physical activity, but only 63% of children do regular physiotherapy at home. Parents could not choose from or rank the appropriate and useful ways of physical activities. Beside the medical team (doctor, physiotherapist, nurse) parents get information from media and internet. They would like to get further information personally in words, in written forms or pamphlets. Parents of children with JIA miss psychic support, alternative treatment options and customised, complex information from the general treatment. Conclusions The findings of this study support the fact that parents of children with Juvenile Idiopathic Arthritis are well informed about the JIA’s inflammatory nature and its symptoms, but they have few and wrong information in connexion with regular physical activity. They have a lack of knowledge about the different kinds of physical activities and sports’ effects on the disease, due to which they choose ergonomically wrong kinds of activities in schools or pre-schools. Based on our results, we would like to develop a complex educational program including physical therapy as well. References [1] K Barut, A Adrovic, S Şahin, Ö Kasapçopur. Juvenile Idiopathic Arthritis. Balkan Med J. 2017Mar; 34(2): 90–101. Disclosure of Interest None declared

Introduction There is evidence for hippocampal dysfunctions in systemic lupus erythematosus (SLE), which may contribute to neuropsychiatric impairments. However, fine structural alterations of the hippocampus have not been investigated in SLE. Methods We measured the volume of hippocampal subfields in 18 SLE patients and 20 healthy control individuals matched for age, gender, and education. The MRI protocol included structural T1 volumes (Philips Achieva 3T scanner, magnetization-prepared rapid acquisition gradient echo (MPRAGE)). For image processing, we used the neuGRID platform and the longitudinal pipeline of FreeSurfer v6.0 with the "hipposubfields" flag. Results Patients with SLE showed reduced volumes of CA1 (Cornu Ammonis 1) and CA4-dentate gyrus subfields relative to the control individuals. Smaller CA1 volumes were associated with worse performance on the Addenbrooke's Cognitive Examination. Conclusions These preliminary results indicate a prominent vulnerability and functional relevance of the CA1 hippocampal subfield in SLE.

Background While ageing the frequency of osteoporosis increases. The most frequent risk factor is falling and consequently bone fractures which in this population is associated with high mortality. According to WHO data, 28–35% of elderly over 65 years falls at least once per year, which increases to 32–47% over 70 years. Objectives The purpose of this randomized control study was to investigate the efficacy of a land-based and water-based exercise program specifically targeting balance to reduce fall risk in patients over 65 years with osteoporosis. We assumed that water-based training program would develop balance efficiently even at elderly people with severe degenerative diseases. Coordination in water is possible to be developed efficiently. Methods The study was carried out in the National Institute of Rheumatology and Physiotherapy. 61 participants were randomized [n=20 sensorimotor training group, n=20 control group (CG)] in the land-based sensorimotor training program (SMT) and 21 people [n=7 Ai Chi group (AC), n=7 water adapted sensorimotor training group (WASM), n=7 control group] in the water-based training program (WBT). The control group did not participate in any training program. The exclusion criteria were neurological, cardiovascular and musculoskeletal diseases, which contraindicated the participation in the training program. Functional Reach Test (FRC), Timed Up and Go Test (TUG), Star Excursion Balance Test (SEBT) and coordination test by stabilometer were used to measure static and dynamic balance. The measurements were performed before and after the training period. The results of the SMT were analyzed with two-sample t-test, and the results of the WBT with non-parametrical methods. The results were defined with p<0,05 statistical margin by SPSS program. Results After 18-weeks of the SMT program significant improvement was experienced in the SMT group compared to the CG with the following parameters: FRC (p<0.001), TUG (p=0.01). In the coordination test no significant difference was found between the SMT and the CG (p=0.09). After 8-weeks of the WBT programs significant improvement in the mediolateral direction of SEBT was detected in the WASM (p=0.028) and in the AC group (p=0.043) compared to the CG. FRC test was shown marginal significance (p=0.075) in the WASM group, while at the AC group remarkable improvement (p=0.043) was recognised compared to the CG. In the TUG test significant improvement was found in the CG and the WASM (p=0.028, p=0.043) compared to the CG. Conclusions The findings from this study support the efficacy of the land- and water-based exercise programs in improving balance in this sample. Our results pointed out that balance improved efficiently even at degenerative joint diseases. Limitations of our research was the small number of the participants and the short duration of the program. In the light of the promising outcome we will continue our research that would result in an efficient fall prevention in this population with high risk of falling. References Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. (2011). Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bulletin, Vol. 22(3–4): 78–83. Disclosure of Interest None declared

Background During rheumatoid arthritis the structure of the foot as well as the plantar pressure surfaces are changing due to the disease. The examinations carried out with the help of machines serve as an overview of the objective state of the foot during function, whereas the functional surveys cumulate the subjective opinion of the patients during the everyday usage of the foot. Objectives In the study research methods were used which help the work of the physiotherapists, have lack of tool demand and make the diagnosis more accurate. Methods The study was carried out from 2015 September onwards among the patients of the National Institute of Rheumatology and Physiotherapy with rheumatoid arthritis (RA) and osteoarthritis (OA). The survey was based on the Foot Functional Index (FFI), the Leed9s Foot Impact Scale (LFIS) and Health Assessment Questionnaire (HAQ). The function of the foot during walking was examined by the Zebris-FDM Treadmill system (7 zones e.x. Forefoot Medial, Lateral, Heel Medial, Lateral). To examine the structural deviations and deformities the Foot Posture Index (FPI) was used. The percentage values of time maximum force measured by the Zebris FDM-T system compared with FPI values. The examination consisted of two groups, patients with RA (n=23, age mean=61,47±11,13 years) and OA (n=22, age mean=59,54±13,73 years) as control group. For statistical analysis Statsoft Statistica v. 7.0 61.0 EN program was used and the Pearson correlation was calculated. The results were defined with p<0,05 statistical margin. Results In the values of the questionnaire based examination, there were significant correlations between FFI and LFISIF (r=0,606; p=0,002), FFI and LFIS (r=0,511; p=0,013), LFISAP and HAQ (r=0,537; p=0,008) in RA. In the control group there were significant correlations between FFI and LFISIF (r=0,430; p=0,046), FFI and LFISAP (r=0,727; p=0,000), FFI and LFIS (r=0,680; p=0,000), FFI and HAQ (r=0,794; p=0,000), HAQ and LFISAP (r=0,635; p=0,001), HAQ and LFIS (r=0,575; p=0,005). In the results of the dynamic and static measurement methods, there was a significant tendency between FPI and Forefoot Lateral (p=0,085) and there was a negative correlation between FPI and Heel Medial (r=-0,922; p=0,026) in RA group (FPI>5). In the OA group there were significant tendencies between FFI and Forefoot Medial (r= -376; p=0,084) and between FFI and Heel Medial (r=-0,395; p=0,068). Conclusions Our study is the first comparison of the physical examination, gait analysis and questionnaires in case of rheumatic foot. In the light of the results it is recommended in the clinical practice that both static and dynamic examinations should be executed. References Baan, H., Dubbeldam, R., Nene, A. V., van de Laar, M. A. (2012). Gait analysis of the lower limb in patients with rheumatoid arthritis: a systematic review. Semin Arthritis Rheum, 6, 768–788, doi: 10.1016/j.semarthrit.2011.11.009. Budiman-Mak, E., Conrad, K. J., Roach, K. E. (1991). The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol, Vol. 44, No. 6, 561–70; Buldt, A. K., Murley, G. S., Levinger, P., Menz, H. B., Nester, C. J., Landorf, K. B. (2015). Are clinical measures of foot posture and mobility associated with foot kinematics when walking? J Foot Ankle Res, Vol. 8, No. 63, doi: 10.1186/s13047–015–0122–5. Disclosure of Interest None declared

Biological agents revolutionised the treatment of chronic inflammatory diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) as well as Crohn's disease (CD), ulcerative colitis (UC) and psoriasis. RA studies highlighted that uptake of biologic drugs varies strongly across Europe and the income of a country is considered as a major determinant factor for usage.1–3 Putrik et al 4 ,5 found that access to biologics in RA—expressed as a composite score of availability, affordability and acceptability—showed a strong positive correlation with gross domestic product (GDP)/capita (r=0.86) in Europe. Much less is known on this topic in AS, PsA and the other three inflammatory diseases. We analysed real-world biologic usage data and their relationships with GDP/capita in the six inflammatory conditions in Bulgaria, the Czech Republic, Hungary, Poland, Romania and Slovakia. According to our previous literature search, there is no precise and comparable country-specific prevalence data in this region.6–8 Therefore, we estimated the biologic treatment rates per 100 000 inhabitants. Considering the total of six diagnoses, …

Background and objectives Several recent studies highlighted the importance of special gene loci related to gout and hyperuricaemia. However, it is remarkable that only a minor fraction of hyperuricemic population produces the symptoms of gout. Discussing the pathomechnism of gouty inflammation a potential autoinflammatory explanation has emerged recently. Induced by MSU crystals, the pathologic activity of a multi-protein complex (NLRP3 inflammasome) might be responsible for the increased activation of interleukin 1-beta (IL-1β), a cytokine playing a central role in inflamation. Toll-like receptors (TLR2–4) have also been studied for the stepped-up production of pre- IL-1β, the pre form of the active metabolit. Human erythrocytes express numerous membrane proteins, several of them already identified as homologue proteins to those with specific function in other tissue, such as urate transporters. Our objective was to verify genetical variations, single nucleotid polymorphisms (SNP) leading to hyperuricemia and gout. We also analysed these gene loci coded proteins linked to elevated urate level, using a unique technique (EryTest) based on the presence of special membrane proteins on human erythrocytes. Materials and methods We studied the results of three groups. Patients with gout, control patients with hyperuricemia but with no arthritic event and patients with normal serum uric acid level. Specific monoclonal antibodies and IgG control were used for quantitative flow cytometry to determine proteins. Polymorphism specific and control primers were used for polymerase chain reaction (PCR) detecting SNPs. Results Increased level of CARD8 polymorphism was found in the gout group compared to the two control groups. Decreased ABCG2 protein expression was detected in heterozygous individuals in gouty and hyperuricemic groups compared to normouricemic controls. Conclusions We presume that depending on complex genetic and environmental factors, patients with CARD8 polymorphisms may have increased inflammatory response and those with decreased ABCG2 protein expression may have higher serum urate levels. From the clinical introduction of EryTest, a simple and rapid clinical method in the evaluation of hyperuricemia is expected. To confirm recent results of genetic variability and the clinical use of EryTest, further investigation is planned.

Objectives. To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time.Methods. In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature.Results. Images from 10 132 participants (56% female, mean age 63.9 years) passed quality checks. Overall, 47% of men and women had DDD grade 3 or more in the lumbar spine and 36% in both thoracic and lumbar spine. Risk ratios for DDD grades 3 and 4, adjusted for age and anthropometric determinants, varied across a three-fold range between centres, yet prevalences were highly correlated in men and women. DDD was associated with flattened, non-ovoid inter-vertebral disc spaces. KL grade 4 and loss of inter-vertebral disc space were associated with higher spine aBMD.Conclusion. KL grades 3 and 4 are often used clinically to categorize radiological DDD. Highly variable European prevalences of radiologically defined DDD grades 3+ along with the large effects of age may have growing and geographically unequal health and economic impacts as the population ages. These data encourage further studies of potential genetic and environmental causes.

Introduction TNF-α plays an important role in host defense against various infections and in the pathogenesis of chronic inflammatory diseases. Therapeutic blockade of TNF-α could be an effective treatment in such cases. However, anti-TNF-α therapy increases the risk of reactivation of serious infections, including tuberculosis (TB). Thus, screening for TB became mandatory, prior to the initiation of TNF-α inhibitor therapy. Aim of the study To assess the performance and characteristics of the Quantiferon TB Gold test (QFT) by screening for TB in three different populations in Hungary: patients with inflammatory rheumatic diseases (RD), health-care workers who serve homeless people (HW) and homeless clients (HL). Methods Between April 2011 and March 2014, samples of 1430 consecutive RD patients, who required or already underwent TNF-a blocking therapy, were screened for latent TB. Two untreated groups, (i) 120 HL and (ii) 46 HW, both considered to be at high risk for TB, were also tested. The QFT was performed according to the manufacturer instructions. The amount of released IFN-g was measured by ELISA in samples stimulated by TB Antigen, saline (NIL) and phytohemagglutinin A (PHA). Results In the RD group, the QFT was negative in 87%, positive in 11%, and indeterminate in 2%. Of the 265 patients, 36 (13.6%) showed inconsistent results on repeat testing. In the HW group, the QFT was negative in 63% and positive in 37%. In the HL group, the QFT was negative in 50.8%, positive in 46.7% and indeterminate in 2.5%. In the RD group, low mitogen response (caused mainly by low lymphocyte count and/or improper specimen handling) and positive results close to the cut-off value of 0.35 IU/mL account for 86% of inconsistent results, while true reversions or conversions only for 14%. Conclusions Based on our results, for better differentiation of non-specific variations, we suggest that a grey zone close to the cut-off value of 0.35 IU/mL (0.35–0.800 IU/mL) should be defined. As for the mitogen response, results higher than 0.5 IU/mL (cut-off), but lower than 2 IU/mL should be interpreted carefully. Repeat testing in such cases could prevent misinterpretations caused by technical errors.

The efficacy of interventions used in real life for the treatment of osteoporosis has not been evaluated on a national basis. We analysed the database of the single Hungarian health care provider between 2004 and 2010. A marked reduction in fracture incidence and hospitalization was seen, which also proved to be cost-effective.