Abstract Background/Aims CRMO is a rare autoinflammatory condition characterised by sterile bone osteolytic lesions which is described mainly in children with a female preponderance. Methods A 31 year-old male presented with a 4-week history of productive cough, abdominal pain, left sided chest pain and right hip pain. He is a smoker with a background of heroin addiction and alcohol abuse. He was homeless and no family history available as he was fostered. His chest radiography was unremarkable but he had inflammatory markers. He was treated for as chest infection and heroin withdrawal. CT abdomen and pelvis demonstrated multiple osteolytic lesions in the pelvis, sternum, thoracic and lumbar spine. His HIV, Quantiferon and blood cultures were negative. His immunoglobulins, urine Bence Jones protein and echocardiogram were normal. In-depth assessment by the Infectious Disease team failed to isolate an infective pathogen. Bone marrow aspirate and trephine were unremarkable. Two CT-guided bone biopsies done twice showed plasma cells and macrophages. His condition deteriorated rapidly over 2 months. He mobility was reduced to wheelchair-bound and had dramatic 10kg weight loss. Results In the absence of an infective or malignant cause, the Rheumatology service was consulted. Having reviewed the extensive data available, he was diagnosed with a likely but unusually aggressive form of adult-onset chronic recurrent multifocal osteomyelitis (CRMO). He was commenced initially on IV methylprednisolone, zoledronic acid, methotrexate and, etoricoxib. Subsequently he was treated with, tocilizumab and teriparatide. Whole body MRI revealed numerous other lesions not evident on previous imaging including lesions of the distal right humerus, proximal right femur and both tibias. His symptoms and inflammatory markers improved substantially over several days following treatment. A repeat full body MRI demonstrated dramatic improvement in the bony lesions. Soon he was able to walk again and gained some weight before he absconded from the hospital. His treatment was changed to tocilizumab infusion and denosumab injection to facilitate compliance. Conclusion This is an unusual fascinating case which posed a significant diagnostic dilemma. Ruling out infection particularly in great challenge in diagnosing CRMO in a male adult who is homeless and a heroin abuser presenting with multifocal osteolytic lesions was challenging. The severity of his condition necessitated using novel treatments such as tocilizumab. Disclosure W. Ng: None. A. Anjum: None. J. Devlin: None. A. Fraser: None.

Abstract Background/Aims Medical students are tomorrow’s doctors and rheumatology seems to be losing its status in school curricula despite its rise in importance. The aim of this study is to determine the knowledge of common rheumatic diseases amongst Year 3 graduate-entry medical students (GEMS) before and after a session of rheumatology tutorial. Methods 19 GEMS who were soon to sit for Year 3 final examination were asked to complete questionnaires pre and post rheumatology tutorial regarding their knowledge and confidence in examining/managing rheumatic diseases namely rheumatoid arthritis(RA), psoriatic arthritis(PsA), osteoarthritis(OA), gout, systemic lupus erythematosus (SLE), scleroderma and ankylosing spondylitis (AS). Knowledge and confidence were measured using a 5-point Likert scale. Results Students were aged 21-30 years. None had previous rotation in rheumatology but 2 (10.5%) had attended a rheumatology clinic before. All were not completely confident in examining the seven rheumatic conditions. >50% were somewhat or fairly confident in examining patients with RA, PsA, OA and gout. The majority found themselves either slightly or not confident in examining SLE, scleroderma and AS patients. Only one stated to have excellent knowledge on the treatment/management of one rheumatic condition, which was gout. 80% or more have above average knowledge on treatment/management of RA, OA and gout. 47.4% rated their knowledge to be poor in the treatment/management of PsA and SLE. Knowledge on treatment/management of scleroderma and AS was below average in > 84%. Following a rheumatology tutorial, everyone had confidence in examining all seven rheumatic diseases. 78.9% and above were either fairly or completely confident in examining patients with RA, PsA, OA, gout, scleroderma and AS versus 52.6% for SLE. All were above average in treating/managing RA, PsA, OA and gout. 78.9% or more have above average knowledge in treatment/management conditions like SLE, scleroderma and AS. Everyone who attended the tutorial felt that it contributed positively in their preparation towards examination and would like to have similar tutorials in future. Conclusion Knowledge in examining, treating and managing common rheumatic diseases is very poor amongst medical students. Rheumatology tutorials are beneficial to increase their knowledge and confidence. Attendance in rheumatology clinics should also be encouraged. P086 Table 1:Confidence in examining patients with common rheumatic conditions pre and post rheumatology tutorialNot confident at all (Pre, Post)Slightly confident (Pre, Post)Somewhat confident (Pre, Post)Fairly confident (Pre, Post)Completely confident (Pre, Post)Rheumatoid Arthritis0, 00, 110, 09, 110, 7Psoriatic Arthritis3, 02, 110, 14, 130, 4Osteoarthritis0, 00, 18, 011, 110, 6Gout1, 03, 18, 17, 120, 5Systemic Lupus Erythematosus5, 07, 45, 52, 90, 1Scleroderma11, 03, 24, 11, 150, 1Ankylosing Spondylitis10, 05, 13, 31, 120, 3 Disclosure W. Ng: None. J. Devlin: None. A. Fraser: None.

Abstract Background/Aims Sleep plays an important component in our lives and sleep abnormalities have been known to be linked with various rheumatic conditions. Obstructive sleep apnoea (OSA) could potentially affect the severity of rheumatic symptoms such as pain, fatigue and also influence the disease activity. This study aims to evaluate the risk of OSA in patients with rheumatic diseases in an Irish cohort. Methods Patients with a diagnosis of a rheumatic disease were recruited from rheumatology outpatients. These patients were asked to complete the Berlin Sleep Questionnaire (BSQ) to evaluate their level of risk for OSA. The Health Assessment Questionnaire (HAQ), Patient Global Assessment (PtGA) and the Physician Global Assessment (PhGA) were also completed. Results These patients were asked to complete the Berlin Sleep Questionnaire (BSQ) to evaluate their level of risk for OSA. The Health Assessment Questionnaire (HAQ), Patient Global Assessment (PtGA) and the Physician Global Assessment (PhGA) 111 patients were recruited. Mean age was 52 years and 22 (19.8%) were males. The most common diagnosis in our cohort was rheumatoid arthritis 54 (45.4%), followed by spondyloarthritis 12 (10.1%), psoriatic arthritis 11 (9.2%), systemic lupus erythematosus 9 (7.6%), Behçet’s disease 7 (5.9%), scleroderma 6 (5.0%) and others 20 (16.8%); with 8 patients having two diagnoses. Our cohort also completed the HAQ which demonstrated 98 (88.3%) having mild to moderate disability and 13 (11.7%) having moderate to severe disability. 39 out of 111 were noted to have a high risk for OSA based on the BSQ. In the high risk cohort, the mean PtGA score was 46.5 while PhGA score was 30.3, compared to the low risk cohort which was 36.7 for PtGA and 24.9 for PhGA. 33 (84.6%) patients in the high risk cohort had mild to moderate disability and 6 (15.4%) had moderate to severe disability as compared to 64 (88.9%) with mild to moderate disability and 8 (11.1%) with moderate to severe disability in the low risk cohort.were also completed. Conclusion This is the first prospective study in Ireland to evaluate the risk of OSA in patients with rheumatic diseases. 35.1% from our cohort were found to be at high risk for OSA and are due to undergo overnight pulse oximetry and polysomnography to objectively assess the presence or absence of OSA. The disease activity reported by both patient and physician along with the level of disability were greater in the high risk cohort. This suggests that OSA increases the likelihood of exacerbating rheumatic activities. Disclosure W. Ng: None. N. Kamarudin: None. A. Anjum: None. J. Devlin: None. A. O'Brien: None. A. Fraser: None.

Abstract Background bDMARDs have been the panacea for rheumatic diseases but their use may increase the risk of infection. Morbidity and mortality in patients with chronic disease can be prevented with influenza and pneumococcal (PCV) vaccinations. Methods We implemented a multifaceted quality improvement (QI) approach at our infusion unit using the Plan-Do-Study-Act methodology. Interventions included training of rheumatology nurses, individual patient consultations and distribution of Arthritis UK booklet on vaccination. During the first cycle, patients on bDMARDs attending the rheumatology infusion unit between January to April 2018 were recruited. Initial data included patients’ demographics, diagnosis, bDMARD, their influenza and PCV vaccination statuses with reasons for not having vaccination. The second cycle was carried out from January to April 2019. Results 92 patients were recruited in the first cycle; mean age was 53.2 years with 63 (68.5%) females. The uptake of vaccination was 52 (56.5%) for influenza and 31 (33.7%) for PCV. More importantly, 39 (42.4%) patients did not receive either vaccination. Of the 18 (19.6%) patients aged ≥65 years, 5 (27.8%) received influenza vaccination alone and 8 (44.4%) received both. The most common diagnosis from our cohort was rheumatoid arthritis (37%), followed by spondylarthritis (13%), Behçet’s disease (9.8%) and others (40.2%). 48 (52.2%) were on rituximab, 37 (40.2%) on infliximab, 6 (6.5%) were on tocilizumab and 1 (1.1%) was on abatacept. 40 (43.5%) who did not receive the influenza vaccination stated that they were either unaware (45%), uninterested (25%), afraid of SEs (12.5%), forgotten (5%), unaware it was recommended (5%). Of the 61 (66.3%) patients who did not receive the PCV, 44 (72.1%) were unaware of its availability, 6 (9.8%) were uninterested, 8 (13.2%) were fearful of side effects (SEs) and 3 (4.9%) were unaware it was recommended. Patients who did not have vaccination were interviewed again during second cycle after QI interventions. There was satisfactory improvement in the vaccination rate of influenza vaccination (71.7%) and PCV (56.5%). The most common reason for the lack of vaccination were fear of SEs for influenza vaccination and unaware of its availability for PCV. 6 (9.7%) had serious infections in the preceding year requiring hospital admission; 3 had chest infections, 1 had urinary tract infection, 1 had cellulitis and 1 had necrotising fasciitis. Conclusion Although the baseline vaccination rate was suboptimal in our cohort, there was a significant improvement after the QI interventions. The lack of awareness is the main reason for failure to be vaccinated. There is a need of a more robust action plan involving both the rheumatology team and primary care physicians to ensure adequate vaccination in immunocompromised patients. In the next step, we also aim to implement these QI interventions to the immunocompromised patients attending outpatient clinics. Disclosures W. Ng None. A. Anjum None. A. Sebastian None. J. Devlin None. A. Fraser None.

were given oral iron therapy (11% received intravenous iron and 14% had combined oral and intravenous treatment).35% reported that they had previously sought medical attention for HMB.68 of the patients who responded reported to having had at least one menstrual period in the last 12 months (this group was aged 17-51 years old).46% reported a regularly monthly cycle.41% of those still menstruating reported two or more of the four symptoms described and thus were consistent with a diagnosis of HMB.25% reported all four symptoms of HMB. Conclusion:The prevalence of HMB in this cohort of patients with SLE (41%) is significantly higher than those seen in the general population (27%).This is important to consider as it confers a greater risk of iron deficiency.

the Meier rate of in the HIP compared the LIP, Log rank P 0.0001. of one-off cost saving of £68000 for the 151 in HIP over six months compared with the LIP rate (approximately £400 per biologic patient). In the proportion of switching in the HIP. 95% at 12 months compared to 75% in the LIP. The asymptote of the LIP curve 80% compared with > 95% switch in the HIP. Future cost savings at these rates approximately for the 151 intervention group (approximately £500/patient biologic). prerequisite for The resulted in a saving estimated per biologic-treated patient over 12 months. We commissioners and to engage in such programmes, put resources into switching (including additional clinicians). We with third to Background: Rheumatoid arthritis (RA) is associated with acceler- ated atherosclerosis and increased risk of morbidity and mortality from cardiovascular disease (CVD) as compared to age and gender- matched controls due to the high prevalence of traditional CVD risk factors (tCVD-RF) and systemic inflammation. EULAR recommends annual cardiovascular risk assessment (CRA) for patients with RA.To assess the compliance with EULAR recommendations and improve- ment in CRA we re-audited RA patients at our rheumatology clinics after devising departmental guidelines and continuous education on CRA based on the initial results from the first audit. The re-audit had same three-fold aims: To determine the prevalence of the tCVD-RF (diabetes, hypertension, hyperlipidemia, long term corticosteroid use and smoking), to assess the management of CVD risk in RA patients in comparison to the EULAR recommendations, and to identify whether RA disease activity is adequately controlled. Methods: This multicenter study involved two teaching hospitals in Mid-West region of Ireland. 100 consecutive patients with definite RA were recruited between May-June 2016 and January-February 2017 in each audit and reaudit phases respectively. A proforma was completed for each patient based on medical notes and electronic record following information at any time since diagnosis of RA: demographic data, disease duration and activity, RF/ACPA status, concomitant ESR and CRP, DAS28, tCVD-RFs, past history of ischemic heart disease (IHD), related co-morbidities (TIA, CVA, PVD, aortic aneurysm) and drug history (current RA, anti-hypertensive and lipid lowering medications). Data on blood pressure (BP), lipid profile and blood glucose (random, fasting or HbA1c) were sought in the preceding 4-years, and if treatment were commenced as per the guidelines. The 10-year risk of fatal CVD was calculated using the and leflunomide (Lef). Baseline screening was assessed by checking for documentation of height, weight, baseline blood tests including virology and documentation of known lung disease and smoking with the relevant investigations when necessary. Specialist nurse referral and content of consultation was assessed for discussion regarding fertility/pregnancy when relevant, intercurrent illnesses and vaccinations. Drug-specific screening and monitoring included folic acid prescription (FA) for MTX, TPMT testing for AZA, ophthalmic review for HCQ as well as weight and blood pressure (BP) monitoring for LEF. Finally all patients were checked for regular blood monitoring at weeks two, four, six and every three months thereafter with the exception of SSA and HCQ monotherapy. Results: Weight and height were not documented in 50.6% and 66.7% of patients respectively. Baseline blood tests were present in all but one patient with the exception of virology. The latter was present in 6.2% of cases only. Smoking was assessed in 92.6% of cases. CXR and pulmonary function tests were warranted for nine patients but were only done in half of the cases. 98.8% of patients were referred to the specialist nurse for DMARD education. Discussion on fertility and pregnancy, where applicable, was discussed in 95% of cases, vaccinations in 97.5% of cases and advice regarding management of intercurrent illness in 2.5% of cases. Drug monitoring at two, four and six weeks was done in 33.3%, 90.1% and 80.2% of cases respectively. BP and weight were checked for all patients on LEF whilst blood monitoring for SSA monotherapy persisted after 1 year in 80% of cases. Drug specific recommendations including FA prescrip- tion, TPMT testing and ophthalmic reviews were done in all patients. Conclusion: This audit showed a high level of concordance with the BSR monitoring guidelines for synthetic DMARDs. Proper documentation of all aspects pertaining to the work-up prior to starting a patient on a DMARD will allow the development of proper screening and monitoring schedules related to the prevention and early detection adverse treatment outcomes. interest. Background: Recent UK epidemiological research suggests a hazard ratio of 1.5 for diabetes in RA patients on prednisolone (cid:2) 5mg or daily. National guidelines produced by NICE, ARMA and BSR set clear standards for screening for diabetes and other cardiovascular risk factors in patients with RA. Further, the Joint British Diabetes Societies have recently produced guidelines for the management of hyperglycaemia in receiving steroid therapy during hospital admission. We therefore assessed our current levels of screening for diabetes against these standards. Methods: The audit was conducted in two rheumatology depart- ments in a district general hospital outpatient setting. Data was collected prospectively using a proforma over a 3 month period in randomly selected patients with RA either commencing or established on oral prednisolone. Results: Data on a total of 82 patients from both hospitals was analysed. Of these 34% were female; mean age 66yr (30-89); 97% were white Caucasian; 14/82 (17%) were know diabetics (all type II, with the exception of two patients). Twenty patients were either commencing prednisolone for the first time or had taken it for < 6months whilst 37/82 (45%) had been established on prednisolone for > 12months. The mean starting dose for prednisolone was 9.5mg (range 5-30mg). Glycated haemoglobin (HbA1c) was measured in 35/ 82 (43%) of patients before and in 40/82 (48%) established on prednisolone. The mean HbA1c prior to treatment was 47.3mmol/mol (normal < 48) and the mean whilst on prednisolone was 45.6mmol/mol. Serum glucose was measured in 34/82 (41%) of patients prior to commencing prednisolone but in only 15/82 (18%) of patients established on prednisolone. The mean pre-steroid serum glucose was

clinical outcomes including digital ulcer (DU) occurrence/healing (n ¼ 7), survival (n ¼ 4), disease severity progression (using domains of Medsger severity scale or other similar composite assessments, n ¼ 4) calcinosis (n ¼ 1), pulmonary arterial hypertension (PAH, n ¼ 1) and a composite analysis of cardiovascular events (n ¼ 1).Most were short-term studies examining outcomes at 3-6 months.There was a moderate-high risk of potential bias across many studies; particularly regarding lack of adjustment for relevant confounding factors (13/18 studies) and appropriate statistical analysis reporting (13/18).All studies reported at least one positive association indicating possible publication bias.Recent multi-centre studies have lower risk of bias enabling stronger conclusions to be drawn (Table 1).Conclusion: There is evidence supporting an association between NC abnormalities (mainly capillary loss) and short-term SSc disease outcomes (particularly the occurrence/delayed healing of DU).More long-term studies are needed.Interpretation of several studies is hampered by potential risk of bias e.g.lack of adjustment for baseline DU in studies evaluating future DU occurrence.Minimising potential bias in future study design and reporting shall help strengthen conclusions concerning the prognostic value of NC in SSc.

hip.Observation at admission: Temperature: 37.7 C, Blood pressure: 148/60 mmHg, Heart rate bpm: 84 beats per minute, Respiratory rate: 15 per minute, Oxygen saturation: 96% on room air On musculoskeletal examination: Right hip was severely tender on both active and passive slightest movements; and she was struggling to weight bear on the right hip.She was tender over the sacrum with no superficial erythema or swelling noted.Spinal assessment was limited but there was no obvious tenderness over the lumbar region -vertebral discs and paravertebral area.Left knee examination identified small effusion at the left knee.There was tenderness on left ankle but there was no synovitis or effusion.Systemic review was unremarkable.Investigations revealed stable renal function, anemia of chronic disease (Haemoglobin 102g/l(115-165), Mean Corpuscular Volume 94Fl(84-105)), White Cell Count 8.1/litre(4 -11), Neutrophils 6.5/litre(1.8-7.5), Platelets 344/litre(150 -450), Liver function test -normal.Inflammatory markers revealed markedly elevated CRP 233 mg/l(0-10) and ESR 95mm/hour.These markers were normal at recent clinic assessments.Uric acid level was 298 mmol/l.Bone profile, phosphate and magnesium were all normal.Chest x-rays was clear, urine dipstick was normal, multiple blood cultures were taken on admission.Xrays right hip and left knee showed mild to moderate degenerative changes and no evidence of chondrocalcinosis.Our working diagnosis at this stage was right hip septic arthritis and discitis.We therefore proceeded with an urgent MRI scan of hip and spine.An urgent orthopaedic opinion was requested with view for right hip aspiration and wash for suspected septic arthritis.We withheld both her disease modifying antirheumatoid drugs.On-call microbiology consultant advised withholding antibiotics until joint aspiration as patient was hemodynamically stable.She has been given oral morphine for pain control.We proceeded with left knee joint aspiration as that was the only accessible joint to aspiration without image guidance.Left kneeaspiratewas clear and strawcoloured.This was sent for microscopy, crystallography and cultures.The local synovial fluid analysis did not identify organisms or crystals.Later that day, MRI scan right hip confirmed large right hip effusion.MRI lumbosacral spine did not suggest features of spinal abscess or discitis.Orthopaedic surgeons review her that day and listed her for right hip aspiration in the operating theatre next morning.Senior orthopaedic hip surgeon reviewed the patient next morning by which point patient had improved significantly and was able to weight bear.The hip surgeon then felt that this is unlikely septic arthritis and decided not to proceed with the previously planned arthroscopy.We still felt that sepsis needed to be excluded in view of a large hip effusion on MRI and a marked inflammatory response.An urgent ultrasound guided right hip aspiration was arranged.However, USS done pre aspiration confirmed that the right hip effusion had resolved completely at 48 hours.This lady continued to make good clinical progress.Blood and urine cultures result were all negative.We felt the acute right hip symptoms may have been an acute RA flare.Interestingly, detailed synovial fluid analysis became subsequently available and confirmed calcium pyrophosphate crystals.This is the full result: Rhagocytes 0%, Crystals Calcium pyrophosphate, Other Fibrin, WBC 4900 WBC/cu mm(WBC/cu mm < 1000 ¼ non inflammatory, ¼/>1000 ¼ inflammatory) We believe the right hip symptoms are more compatible with an episode of acute pseudogout and are supported by identification of calcium pyrophosphate crystals in synovial fluid of other less symptomatic joint.Ideally the symptomatic joint aspirate would settle this issue but that could not be achieved in our patient.This patient had not received any antibiotics, corticosteroid or NSAIDs in addition to the opiate analgesia during her hospital stay.She improved back to her baseline and was dischargedto be followed up in 8weeks.Discussion: This case demonstrates the importance of aspirating seemingly quiescent joints in patients who present with suspected septic arthritis or there mimics as these joints may not always be amenable to aspiration.Imaging the affected joint does not give a definite diagnosis either.Chondrocalcinosis -calcification of cartilage identified on radiographs prompts clinicians to consider CPPD disease as a potential cause but is not diagnostic.In about 40% of patients with crystallography proven pseudogout, the radiographs may not identify chondrocalcinosis.Also, CPPD is not the only crystal that leads to chondrocalcinosis.X-rays are not usually helpful as chondrocalcinosis in the joint spaces may only be present in about 40% of the cases(1) RA is rarely reported to be associated with pseudogout.Alhadad et al (2) showed that 8 patients amongst 62 patients with pseudogout were found to have RA They also noted that there is associated increased severity of attack in patients with background inflammatory arthritis such as RA.However, the study was not powered to be of statistical significance.In our patient, the identification of associated CPPD disease will be helpful for long term management.If CPPD was not identified, future flares could be attributed to RA flare leading to unwarranted changes in RA therapy.Low dose Prednisolone would be a potential option in this elderly lady with RA should she experience further episodes of pseudogout as it will help both RA and pseudogout flares.This is a rare clinical case of acute pseudogout in an elderly RA patient whichmimicked septic arthritis.Key learning points: Synovial fluid analysis and culture of synovial aspirate from less symptomatic joint can be valuable in patients with acute hot joints which may not be readily accessible for aspiration.Absence of chondrocalcinosis doesnot exclude the diagnosis of pseudogout. 37.

B cells may play a pivotal role in the pathophysiology of DM, and reports have claimed that targeting B cells is a viable treatment option in patients with dermatomyositis. A 20-year-old girl presented in October 2007, with few weeks’ history of proximal muscle weakness. Gottron’s papules were noted on her knuckles. She had normal inflammatory markers and negative autoantibody screen. Her CPK was 7,000 U/L (normal range 0–170) with an LDH of 1,300 U/L (normal range 266–500). EMG and muscle biopsy was consistent with active myositis. She had normal pulmonary function tests. HRCT showed no interstitial lung disease. She was started with 60 mg glucocorticoids (1 mg/kg), with a good clinical response. However, any attempt to taper down the steroid dose led to recurrence of her symptoms. The options of available immunosuppressive therapies, including the experimental usage of rituximab, were discussed with her; averse to long-term systemic treatments, she opted to try a course of rituximab. She had rituximab 1,000 mg on days 0 and 14, and her glucocorticoids were tapered in next few weeks. Now, 24 months since her rituximab infusions, she remains in complete clinical and biochemical remission and is naïve to other immunosuppressive agents apart from glucocorticoids and rituximab. Depleting peripheral B cells with rituximab (one course) in our patient has led not only to complete resolution of muscle and skin disease (induction) but also remains off all immunosuppressives including glucocorticoids.

The outlook of inflammatory joint diseases has changed significantly with the advent of TNF blockers. However, these advances come with a trade off-risk of infections, especially tuberculosis. The Irish society of rheumatology has proposed guidelines to investigate and treat latent TB infection (LTBI), which is in accordance with majority of international recommendations. This protocol requires that every patient with LTBI should have chemoprophylaxis. INH and different anti-rheumatic drugs are known to cause hepatic and gastrointestinal complications. We sought to investigate the toxicity of adding prophylactic anti-TB medications to different DMARDs and anti-TNF agents. We prospectively documented the course of all patients who were prescribed chemoprophylaxis for LTBI, from August 2007 to August 2008. Arrangements were made for central re-issuing of prescription of INH or rifampicin, after reviewing monthly liver function tests and following telephone interview seeking presence of adverse events. Out of 132 patients who were commenced on different TNF blockers, only 23 patients (17%) were diagnosed with LTBI and were given prophylaxis as per recommended guidelines. Thirty-nine percent (9 out of 23) of patients discontinued INH because of adverse events. Primary reason for discontinuation in these 9 patients was as follows: 3 patients got marked transaminitis (transaminases > 5 times the normal limit), 5 patients had non-resolving gastrointestinal intolerance (mainly nausea), and one patient developed non-resolving rash. We have found a significant number of our patients (39%) who could not continue anti-TB prophylaxis due to either gastrointestinal intolerance or hypertransaminesemia.

Aims: The aim of this study was to investigate the prevalence of chronic kidney disease (CKD) among comparable patients with rheumatoid arthritis (RA) and seronegative inflammatory arthritis, and to explore any predictive factors for renal impairment.Methods: Consecutive patients with peripheral joint disease (oligo and polyarthritis) were recruited from our inflammatory arthritis clinics. We divided patients in two groups: RA group and seronegative inflammatory arthritis group. The cohort consisted of 183 patients (RA = 107, seronegative arthritis = 76 [ psoriatic arthritis = 69, undifferentiated oligoarthritis = 7]). Estimated glomerular filtration rate (eGFR) was calculated using the established Modification of Diet in Renal Disease equation. Demographic details, disease-specific characteristics, anti-rheumatic drugs and the presence of cardiovascular diseases were recorded.Results: In total, 17.48% (n = 32) of the cohort had CKD. There was no statistically significant variation between the two groups as regards baseline demographics, disease characteristics, use of anti-rheumatic drugs and the presence of individual cardiovascular diseases. We found that eGFR and the presence of CKD were similar among these groups. Among patients with CKD, 72% had undiagnosed CKD. No association of statistical significance was noted between CKD and the use of corticosteroids, disease-modifying antirheumatic drugs and anti-tumor necrosis factor agents. The association of cardiovascular diseases with CKD remained significant after adjusting for confounders (age, gender, duration of arthritis, high C-reactive protein, use of anti-rheumatic drugs).Conclusions: Patients with inflammatory arthritis are more prone to have CKD. This could have serious implications, as the majority of rheumatology patients use non-steroidal anti-inflammatory drugs and different immunosuppressives, such as methotrexate. No association of kidney dysfunction was noted with inflammatory disease-specific characteristics; rather it appears to have a positive independent association with cardiovascular diseases.

Objectives. Pulmonary complications of RA are well described. Although some are benign, interstitial lung disease (ILD) has a poor prognosis. Few RA inception cohorts have reported the natural history of ILD related to RA (RA-ILD). We examine its incidence, outcome and prognostic indicators. Methods. Extra-articular features and comorbidity have been recorded yearly in a well-established inception cohort of RA with a 20-year follow-up. Standard clinical, laboratory and radiological measures of RA were recorded at baseline and yearly. Details of deaths were provided by a national central register. Results. Out of 1460 patients, 52 developed RA-ILD, half either at baseline or within 3 years of onset. The annualized incidence was 4.1/1000 (95% CI 3.0, 5.4) and the 15-year cumulative incidence 62.9/1000 (95% CI 43.0, 91.7). Incidence of RA-ILD was associated with older age, raised baseline ESR and HAQ. Evidence to implicate any drug effect (e.g. MTX) was lacking. Of these patients, 39 died, attributed to RA-ILD in 28. Median survival following diagnosis of RA-ILD was 3 years. Conclusions. RA-ILD is an important and early feature of RA. It is related to disease activity and has a poor prognosis. Further studies are required to determine whether screening for pulmonary disease would identify these patients at an earlier stage.