Rheumatology

PC0013: Clinical profiling of Psoriatic arthritis: An observational study from Karnataka psoriatic arthritis cohort

K Chanakya, Chandrashekhar Srikanntiah¹, Sharath Kumar², Vikram Haridas³, Vijay Rao⁴, Ramesh Jois⁵, Manisha Daware⁶, Shweta Singhai⁷, B G Dharmanad⁵, Promod Chebbi⁸, R Subramanian⁹, Ashwini Kamath¹⁰, Uma Karjiigi¹¹, Vikram Raj K Jain¹², Chethana Dharmaplaiah¹³, Shiva Prasad¹⁴, C Srinivas¹⁵, J Ramya, Benzeeta Pinto, Harshini¹⁶, Mahendranath¹⁷, Vineeta Shobha; St. John's Medical College Hospital,¹Chanre Rheumatology and Immunology Research Centre,²Columbia Asia Hospital,⁴Manipal Hospitals,⁵Vikram Hospital,⁶Narayana Health City,⁷Sakra Hospital,¹¹Apollo Hospital,¹³Mahaveer Jain Hospital,¹⁴Aster CMI Hospital,¹⁵Fortis Hospital,¹⁶Sparsh Hospital,¹⁷Samarpan Health Centre, Bengaluru,³Arthritis Specialty Clinic, Hubli,⁸SDM Medical College, Dharwad,⁹JSS Medical College,¹²Apollo BGS Hospital, Mysore,¹⁰Yenepoya Specialty Hospital, Managlore, Karnataka, India

Introduction: Clinical patterns and disease activity burden of psoriatic arthritis (PsA) varies in different parts of the world. There are limited studies from the Indian subcontinent.

Aims: To study the cutaneous and articular profile of PsA and describe their disease activity with validated outcome measures.

Methods: This is a multicenter, cross-sectional, non-interventional study done in the Karnataka Psoriatic Arthritis Cohort (KPsAC). All consecutive PsA patients defined by CASPAR or expert diagnosis were evaluated using structured CRF over 6 months from 17 Rheumatology centers.

Results: Demographics and disease characteristics of 378 patients enrolled is depicted in [Table 1]. In 238 (63.1%) patients, psoriasis preceded PsA while in 52 (13.7%), PsA preceded psoriasis. Mean PASI score was 4.0±7.9, mild (0-5) skin disease in 295(79.3%) and severe (>10) skin disease noted in 41(11.0%). Mean DAPSA was 19.2±16.5. Patients in remission (DAPSA:0-4) being 67(19.3%), low disease activity (5-14) in 106(30.6%), moderate disease activity (14-28) in 86(24.8%) and high disease activity (>28) in 89(25.7%). Mean HAQ-DI is 0.28±0.41 with mild to moderate disability in 48.8%. MDA is achieved in 130(35%) of patients.

Table 1: Demographics and disease characteristics Click here to view

Conclusions: Arthritis precedes skin disease in about 14% of patients. Despite mild skin disease in majority, nearly half of the patients have moderate to severe joint activity. Mild to moderate functional disability is noted in almost half of our cohort.

PC0014: Health assessment questionnaire- disability index in psoriatic arthritis is driven by inflammation: Observational data from Karnataka psoriatic arthritis cohort

K Chanakya, Chandrashekhar Srikanntiah¹, Sharath Kumar², Vikram Haridas³, Vijay Rao⁴, Ramesh Jois⁵, Manisha Daware⁶, Shweta Singhai⁷, B G Dharmanad⁵, Promod Chebbi⁸, R Subramanian⁹, Ashwini Kamath¹⁰, Uma Karjiigi¹¹, Vikram Raj K Jain¹², Chethana Dharmaplaiah¹³, Shiva Prasad¹⁴, C Srinivas¹⁵, J Ramya, Benzeeta Pinto, Harshini¹⁶, Mahendranath¹⁷, Vineeta Shobha; St. John's Medical College Hospital,¹Chanre Rheumatology and Immunology Research Centre,²Columbia Asia Hospital,⁴Manipal Hospitals,⁵Vikram Hospital,⁶Narayana Health City,⁷Sakra Hospital,¹¹Apollo Hospital,¹³Mahaveer Jain Hospital,¹⁴Aster CMI Hospital,¹⁵Fortis Hospital,¹⁶Sparsh Hospital,¹⁷Samarpan Health Centre,³Arthritis Specialty Clinic, Hubli,⁸SDM Medical College, Dharwad,⁹JSS Medical College,¹²Apollo BGS Hospital, Mysore,¹⁰Yenepoya Specialty Hospital, Managlore, Karnataka, India

Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory disease with significant functional impairment. HAQ-DI is a reliable and validated outcome measure for a variety of arthritis including Psoriatic arthritis. Disease characteristics contributing to the functional limitation in PsA have rarely been reported in Indian population.

Objective: Current study aims to evaluate the Indian version of HAQ as an outcome measure in the assessment of patients with psoriatic arthritis (PsA) among those who have received immunosuppressive treatment for 6 months or more in Karnataka Psoriatic Arthritis Cohort (KPsAC).

Methods: The Indian version of HAQ was administered to all consecutive patients enrolled in KPsAC between April and August 2019. Clinical assessments were performed according to a specially designed CRF. The Indian HAQ comprised 12 questions (nine basic and three advanced ADL, on the standard HAQ format) relevant to the Indian population.

Results: From KPsAC cohort of 378 patients, 142(37.4%) were extracted, those on treatment with a rheumatologist for ≥6 months. Mean age of this cohort was 38.3(±15.6) years, half were men, and mean arthritis duration was 6.5(±6.9) years. The mean HAQ score was 0.24(±0.36), mild-moderate (0-1) in 64(46.0%) and moderate-severe (1-2) in 9(6.3%). Parameters contributing to Moderate- High HAQ-DI are depicted in table No.1. HAQ-DI was not different between gender and age groups. Duration of arthritis was not associated with HAQ. Tender joint count (r=0.29, 95%CI=0.13-0.43, p<0.0005), ESR(r=0.22, 95%CI=0.05-0.38, p=0.01) and CRP (r=0.27, 95%CI=0.10-0.42, p=0.001) had a minor correlation with HAQ.

Conclusion: Indian version of HAQ could be efficiently employed to assess outcomes in our cohort. In-spite of being on therapy for at least 6 months, over half of the patients had mild to moderate disability indicating the high burden of inflammation.

Table 1: Associations of Health Assessment Questionnaire Click here to view

PC0015: Prevalence of co-morbidities in psoriatic arthritis and their impact on disease measures: an observational study from Karnataka psoriatic arthritis cohort

K Chanakya, Chandrashekhar Srikanntiah¹, Sharath Kumar², Vikram Haridas³, Vijay Rao⁴, Ramesh Jois⁵, Manisha Daware⁶, Shweta Singhai⁷, B G Dharmanad⁵, Promod Chebbi⁸, R Subramanian⁹, Ashwini Kamath¹⁰, Uma Karjiigi¹¹, Vikram Raj K Jain¹², Chethana Dharmaplaiah¹³, Shiva Prasad¹⁴, C Srinivas¹⁵, J Ramya, Benzeeta Pinto, Harshini¹⁶, Mahendranath¹⁷, Vineeta Shobha; St. John's Medical College Hospital,¹Chanre Rheumatology and Immunology Research Centre,²Columbia Asia Hospital,⁴Manipal Hospitals,⁵Vikram Hospital,⁶Narayana Health City,⁷Sakra Hospital,¹¹Apollo Hospital,¹³Mahaveer Jain Hospital,¹⁴Aster CMI Hospital,¹⁵Fortis Hospital,¹⁶Sparsh Hospital,¹⁷Samarpan Health Centre, Bengaluru,³Arthritis Specialty Clinic, Hubli,⁸SDM Medical College, Dharwad,⁹JSS Medical College,¹²Apollo BGS Hospital, Mysore.¹⁰Yenepoya Specialty Hospital, Managlore, Karnataka, India

Introduction: Co-morbidities frequently accompany Psoriasis and Psoriatic arthritis(PsA) and add to the disease burden. Indian studies on co-morbidities in PsA are sparse.

Aims: To identify the co-morbidity burden in patients with PsA and evaluate its impact on the disease activity measures.

Methods: This is a multicenter, cross-sectional, non-interventional study done in the Karnataka Psoriatic Arthritis Cohort(KPsAC) in which consecutive PsA patients were evaluated through a structured CRF from 17 Rheumatology centers. A comprehensive psoriatic co-morbidity index was calculated for all enrolled patients. Psoriasis Area and Severity Index(PASI), Disease activity in PsA(DAPSA), Health assessment questionnaire-disability index(HAQ-DI) were correlated with co-morbidity index.

Results: The mean age at diagnosis of 378 enrolled patients was 39.2±14.9 years, with male predominance(M:F=13:10.5). Mean duration of PsA in cohort is 5.2(±6.0) years and 150(39.5%) patients had one or more co-morbidities. The mean psoriatic arthritis co-morbidity index was 1.04±2.24. The most prevalent co-morbidities were hypertension(18.7%) followed by type II diabetes(13.9%), smoking(5%), PsA disease severity(3.43%), anxiety(3.16%), IHD & endocrine disease(2.63% each) and depression(2.37%). Others were present in <2% each of cohort. Family history of cardiovascular disease or stroke was present in 29(9.5%). Patients with co-morbidities had significantly longer duration of arthritis than those without co-morbidities(p=0.04). HAQ-DI was significantly more in PsA patients with co-morbidities(p=0.02). Co-morbidity index did not correlate with gender, DAPSA and HAQ-DI. Infections were found in 42(11.2%), of which skin was the commonest site accounting for 50% while other bacterial infections were seen in 14.2%. Seven patients needed hospitalization due to infections.

Conclusion: Nearly 40% of PsA patients have co-morbidities and their presence was associated with greater functional disability. Longer disease duration was associated with presence of co-morbidities. Detection and control of co-morbidities must be an integral part of PsA management.

PC0016: Prevalence of low bone mineral density in patients of ankylosing spondylitis, correlation with disease activity and serum sclerostin levels

Akhil Pawan Goel, Anupam Wakhlu, Puneet Kumar; King George's Medical University, Lucknow, Uttar Pradesh, India

Background: In AS, two bone remodeling processes take place; pathological new bone formation in the cortical zone of vertebrae, the facet joints and excessive loss of trabecular bone in the centre of the vertebral body causing osteoporosis(OP).OP expressed as reduced BMD is a common complication in AS that has been shown to exist in mild and early disease. TNFα is responsible for induction of Dickkopf-1 and sclerostin, which downregulates bone formation by inhibiting Wnt and bone morphogenic proteins.

Objectives:

1) To study the prevalence of low BMD in AS

2) To correlate low BMD with disease activity

3) To correlate serum sclerostin and cytokines-TNFα, IL-17, IL-22 with clinico-radiological and laboratory parameters of disease activity and BMD

Methods: Fifty consecutive patients fulfilling the ASAS 2009 classification criteria for axial spondyloarthritis were enrolled; all other secondary spondyloarthropathies were excluded. An equal number of controls were recruited. Other causes of secondary osteoporosis were excluded. BASDAI, ASDAS-ESR and CRP,mSASSS were calculated. BMD was measured at A-P lumbar spine, neck of femur, lateral lumbar spine using DEXA. Serum sclerostin,TNF-α, IL-17A,1L-22 and PTH levels were measured by commercial ELISA kits according to the manufacturer's protocol.

Results: Mean BMD at various sites was significantly lower in patients. Patients having osteoporosis and low BMD at AP and lateral spine were 38% and 72% respectively; at neck of femur,20% and 68% of patients had osteoporosis and low BMD respectively. BMD at neck of femur had significant positive correlation with BASDAI. Serum sclerostin levels were significantly higher in patients and had significant negative correlation with mSASSS.

Conclusion: Study showed a high prevalence of low BMD using Z-scores and T-scores which was higher than the previous studies; BMD at neck of femur can be used in advanced disease when BASDAI is low; Low sclerostin has a role in formation of syndesmophytes.

PC0017: Real-world experience of efficacy and patient reported outcome measures of tofacitinib in patients with active rheumatoid arthritis

Ramakrishna Rao Uppuluri, Maryam Younis, Archana Rani, Shashikala Arava, Datta Kumar, J Shivanand, C Satyavati; Sri Deepti Rheumatology Centre, Hyderabad, Telangana, India

Background: In Real-world practice, efficacy of the treatment of active rheumatoid arthritis (RA) is analyzed by several measurements such as Disease Activity Score (DAS). It is also essential to measure the Patient Reported Outcome Measures (PROMs) during the treatment.

Objective: The aim of the study is to analyze the efficacy and PROMs of Tofacitinib, a JAKinib (Janus Kinase inhibitor) in patients with active RA not responding to conventional, synthetic disease modifying anti rheumatoid drugs (csDMARDs) in routine clinical practice.

Methods: Data of 50 patients with active RA from a single centre in south India from January 2017 to 2019 was obtained using standardized formats at baseline, 1 and 3 months. Tofacitinib was added 5mg twice daily to the patients with inadequate response to csDMARDs.Mean change from baseline in Tender Joint Count (TJC), Swollen Joint Count (SJC), Patient Global Assessment (PGA) 0-100mm, ESR mm hr, DAS -28 and Health Assessment Questionnaire- disability index( HAQ-DI) were evaluated throughout.

Results: Forty nine (96%) among 50 patients were seropositive for RA (RF/ACPA); 44 (88%) were females, mean (range) age 51.9 (20-77) years with mean disease duration 9.4 (1-25) years. All the patients had active RA with TJC 13 (range 1-28), SJC 6 (1-25), ESR (mm/hr) 64 (8-132) and DAS 6.8 (2.4-8.9). Among the PROMs, PGA was 80 mm (10-100) and HAQ-DI 2.2 (1.3-3) before treatment.All the parameters pertaining to efficacy and PROMs were better with the addition of Tofacitinib seen as early as 1 month and better by 3 months [Figure 1].

Figure 1: TJC, SJC, HAQ-DI and DAS-28 before and after treatment Click here to view

Conclusion: Patients with active RA having inadequate response to csDMARDs showed good clinical response with addition of Tofacitinib. DAS and PROMs improved as early as 1 month and became better by 3 months. It needs further studies involving more patients to identify the importance of PROMs in Real-World clinical experience.

PC0018: To study the correlation of clinical parameters and nerve conduction velocity test findings in rheumatoid arthritis patients with peripheral neuropathy

Daisy Dutta, Chitralekha Baruah, Subhajit Das; Department of Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India

Background: Rheumatoid arthritis (RA) is a chronic multisystem inflammatory illness causing erosive and destructive arthritis of multiple small and large joints with various extra-articular manifestations including peripheral neuropathy which can lead to significant functional limitations. Nerve conduction studies revealed peripheral neuropathy in RA patients without clinical signs and symptoms of neuropathy.

Objectives: 1) To study the prevalence and types of peripheral neuropathy in RA patients and to correlate the clinical parameters with nerve conduction studies. 2) To correlate neuropathy in RA patients with disease severity.

Methodology: 41 cases of RA (diagnosed as per ACR/EULAR criteria 2010) were enrolled in the study and were subjected to detailed clinical examination and electrophysiological test. The demographic and clinical parameters were compiled, and Chi-square test was applied for statistical analysis.

Summary of Results: Of the 41 RA patients, 20 (48.78%) had peripheral neuropathy electro physiologically. Only 9(45%) out of 20 had clinical symptoms of neuropathy while 11(55%) patients had subclinical neuropathy. Sensorimotor neuropathy was the most common form 12(60%) found in our study, followed by motor neuropathy 6(30%) and 1each of mononeuritis multiplex and entrapment neuropathy. Statistically significant association was found between presence of peripheral neuropathy and disease severity (DAS 28), rheumatoid factor positivity and acute phase reactants (ESR and CRP).

Conclusion: Peripheral neuropathy is one of the common extra-articular manifestation of RA. The present study shows high prevalence of subclinical neuropathy in RA patients with high disease activity. Hence, Nerve conduction velocity studies to be undertaken in RA patients when there is high degree of suspicion.

PC0019: Evolution of mixed connective tissue disease: Results: from a single center - prospective observational study

S Karthikeyan, T N Tamilselvam, R Ramesh, S Mythili: Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India

Background: MCTD is an evolving disease rather than one specific CTD. MCTD would more accurately be termed as undifferentiated autoimmune rheumatic disease.

Objectives: To assess the clinical profile and outcome of MCTD patients.

Methods: This study was conducted at Rajiv Gandhi Government General Hospital over 21 months between November 2017 to July 2019. Alarcon Segovia criteria was applied for diagnosis. Patients with diagnosis of MCTD (including new and old cases) were followed up periodically, based on clinical and immunological profile to assess the phenotypic change in course of the disease.

Results: Study population consists of 30 patients, most of them are females except one male patient and 2 childhood cases. In our study most common clinical presentation was Raynaud's phenomenon (96%) followed by polyarthritis (86%), puffy fingers (86%), PHT (70%), ILD (66%), myositis (60%), gangrene (6%), peripheral neuropathy (3%). None of the patient had renal involvement. PHT was severe in nature in our study. UIP (63%) was the most common ILD pattern followed by NSIP (3%). Among 2 childhood cases one patient presented with Raynaud's phenomenon, myositis, polyarthritis, ILD/PHT, second case presented as PUO. In our study follow up 90% of patients stayed as MCTD without progression to another well-defined connective tissue disease. Among 30 patients, 4 (13%) progressed to another well-defined CTD (2 patients evolved into Limited SSc, one as SS, another one as SLE) after a mean disease duration of 3.4 years for SSc,2.8 years for SS, 6.7 years for SLE.

Conclusion: It is mandatory to have a long term follow up of MCTD patients to know the phenotypic stability of the disease. No need for all MCTD patients to progress to another CTD. There is a possibility that disease can remain as MCTD or even can go into remission.

PC0020: High disease activity at onset is not associated with chronicity in chikungunya arthritis

Benzeeta Pinto, Anu Mohan Desai, Farha Farruqh, Ramya Janardana, Kodishala Chanakya, Vineeta Shobha; Department of Clinical Immunology and Rheumatology and Radiology, St John's Medical College, Bengaluru, Karnataka, India

Introduction: Chikungunya fever is a remerging disease is India and may lead to post chikungunya inflammatory rheumatism.

Objective: To assess the clinical and ultrasound features of chikungunya arthritis in the subacute phase and determine if high disease activity is associated with chronic disability.

Methods: We conducted a prospective observational of all patients who presented with subacute chikungunya arthritis ( joint pains of 2 weeks to 3 months following fever) over 1 year duration. Chikungunya fever was diagnosed by consistent clinical picture with IgM positivity. Clinical and disease activity assessments were done by BP. Ultrasound was done by a radiologist(FF).

Results: Twenty three patients( 18 females ) with a mean age of 44.09±9.9 years were included. he patterns of joint involvement was similar to rheumatoid arthritis, 22 patients had polyarticular disease. Rheumatoid factor was positive in 1, antiCCP was negative in all. Ultrasound revealed synovitis and tenosynovitis both on grey scale and power doppler in most patients.[Table 1] Mean DAS28 score , Indian HAQ and US7 score at presentation were 4.14±1.3, 0.81±0.5 and 17.22± 8.1 respectively. US7 score did not show a good correlation with other parameters of disease activity and HAQ. Twenty patients were treated with a short course of IM/oral steroids, methotrexate and hydroxychloroquine were given in 15 and 3 patients respectively. One year follow up was available in 20 patients. Only 2 patients continued to be on treatment. The HAQ score at follow up was 0.11±0.14. No correlation was found between DAS28, SJC, TJC, ESR, US7 score ,HAQ score or pain NRS at presentation with HAQ and pain NRS at follow up.

Table 1: Clinical features and disease activity parameters in Chikungunya arthritis Click here to view

Conclusion: Chikungunya arthritis is a self-limited polyarthritis closely resembling seronegative RA. High disease activity at presentation did not correlate with disability and pain at one year of follow up.

PC0021: Fever in early lupus: impact on classification and association with clinical features

Vineeta Shobha, Asma Chougule, V S Negi, Liza Rajasekhar, Manish Rathi, Ashish Jacob Mathew, Parasar Ghosh, Ranjan Gupta, Bidyut Das, Ramnath Misra, Benzeeta Pinto, Avinash Jain, Murugavangini, Sindhura Gajula, Janany Parathasarthy, Parmeshwar Sandhu, Saumya Ranjan Tripathi, Abhishek Tripathi, Amita Aggarwal; Indian SLE Inception Cohort for Research, India

Background: EULAR/ACR has recently proposed a new set of classification criteria for SLE based on weighted items¹. Based on premise that fever is an early manifestation of lupus, and that it assists in classification of early SLE, it has been included as a new component for the first time in lupus classification.

Aim: 1) To understand impact of fever on sensitivity of EULAR/ACR 2018 classification criteria in early SLE using patients recruited in INSPIRE Cohort over last 11 months. 2) To study association of fever with various clinical and immunology domains.

Methods: Indian SLE inception cohort for research (INSPIRE) is a Multi-Institutional Network Program on SLE to understand its diversity. All consecutive patients fulfilling SLICC criteria and symptom duration less than 3 years were included in this Cohort. Association of fever with 6 clinical and 3 immunology domains assessed. Sensitivity of ACR/EULAR classification evaluated in early lupus (onset of symptom <6months).

Results: In cohort of 487 patients, median age 25 + 9.8 years, F:M ratio= 10:1, fever was documented in 338 patients as one of the symptoms. Among these, 145 patients had duration of illness <6 months. Of these 135 patients fulfilled the ACR /EULAR classification criteria (93%). When fever was removed from the scoring, sensitivity was lowered to 89% and an additional 5 patients would not fulfil ACR/EULAR criteria. Fever was associated with minor manifestations of lupus rather than severe lupus such as renal or neuropsychiatric lupus.

Conclusion: Fever in constitutional domain of ACR/EULAR classification criteria adds value to diagnosis in early lupus (< 6months) and is more often associated with non- serious manifestations of lupus.

Table 1: Association of fever with American College of Rheumatology/European League Against Rheumatism Click here to view

Reference

1. Arthritis Rheumatol 2019;1-13. [DOI 10.1002/art.40930].

PC0022: ANA as obligatory entry criteria decrease sensitivity of ACR/EULAR criteria for lupus classification

Vineeta Shobha, Benzeeta Pinto, V S Negi, Liza Rajasekhar, Manish Rathi, Ashish Jacob Mathew, Parasar Ghosh, Ranjan Gupta, Bidyut Das, Ramnath Misra, Avinash Jain, Chengappa, Asma Chougule, Murugavangini, Sindhura Gajula, Janany Parathasarthy, Parmeshwar Sandhu, Saumya Ranjan Tripathi, Amita Aggarwal, Indian SLE Inception Cohort for Research, India

Background: Indian SLE Inception Cohort for Research (INSPIRE) is a Multi-institutional Network Program on SLE to understand its diversity. EULAR/ACR has proposed a new set of classification criteria for SLE based on weighted items and the use of ANA as an entry criterion.^[1]

Aim: To evaluate performance EULAR/ACR 2018 classification criteria for SLE using patients recruited in INSPIRE Cohort focusing on ANA as entry criteria.

Methods: All consecutive patients fulfilling SLICC criteria for SLE and disease duration less than 3 years were included from INSPIRE Cohort. EULAR/ACR classification criteria was applied for each patient.

Results: In cohort of 487 patients enrolled so far, median age was 25 + 9.8 years, F:M ratio= 10:1, median disease duration was 9 months. The mean SLICC score was 7.4 and 12 patients were ANA negative. Therefore, ACR/EULAR criteria cannot be applied to 2.5% of SLICC approved and expert physician diagnosed cohort of SLE. Seven of them belonged to early disease subset (duration of illness<12 months). However, all 12 ANA negative patients fulfilled ACR/EULAR criteria independently, and 9 of them were scored in highly specific antibody domain. Furthermore, another 12 did not fulfil ACR/EULAR criteria as the total score was <10. Thus, 24 of 487(5%) could not be classified as SLE using ACR/EULAR criteria.

Conclusion: ACR/EULAR has poor sensitivity of 95% in our cohort. ANA as obligatory entry criteria exclude 2.5% of patients, hence this may need to be revised.

PC0023: Comparison of results: of line immuno assay with indirect immunofluorescence for detection of antinuclear antibodies in patients with SLE at a tertiary care centre

Aishwarya Ramachandran, Rajeswari Sankaralingam, Kennedy Kumar Palraj, Balaji Chilukuri, Saranya Chinnadurai, Vignesh Mantharam, Ramu Ramaswamy, Shanmugesh Selvaraj; Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India

Background: Detection of antinuclear antibodies (ANAs) aids in the diagnosis of autoimmune diseases. The Indirect Immunofluorescence assay (IIF) is routinely used as a first line screening test to detect autoantibodies. Line immunoassays (LIA) is further done to detect specific autoantibodies.

Objective: The objective of this study was to compare the two techniques - ANA IIF pattern with LIA autoantibodies in Systemic lupus erythematosus (SLE) patients and to detect a definite correlation between the two methodologies.

Methods: The study included 866 serum samples obtained from patients suspected with SLE in a tertiary care centre over a period of 22 months. Analysis of ANA by IIF was done in all 866 samples.Samples positive for ANA-IIF was subjected to LIA testing.

Results: Out of 866 samples tested, 145 ( 16.7%) were positive for ANA by IIF . On further testing of the ANA-IIF positive samples for specific antibodies by LIA a total of 103 (71.3%) samples were positive for both ANA IIF and LIA and 42 ( 28.9%) showed negativity with line immunoassay.Nucleus speckled pattern was the most common(n=53;51.4%) pattern. The second most common was homogenous (n = 41; 39.9%) pattern followed by Mixed pattern (n = 5; 4.8%) and cytoplasmic pattern (n = 4; 3.8%). In association with these ANA patterns specific autoantibodies were detected by LIA. Correlation with LIA Results: with the following patterns were speckled – RNP/Sm, Sm , PCNA and SSA ( n=46; 86.6%) , homogenous - Ds DNA, histone ,nucleosomes (n = 39; 97.5%) , Mixed pattern - Ds DNA, RNP/Sm ,nucleosomes ( n= 5 ; 100%) and Cytoplasmic pattern- Ribosomal P protein ( n= 4 ; 100%).

Conclusion: Fluorescent patterns of ANA IIF can only predict the presence of antibodies and further confirmation with LIA aid to detect specific antibodies to arrive at a diagnosis of SLE.

PC0024: Distal forearm and femoral neck as surrogate sites for measurement of spinal BMD in patients with advanced AS with 'bamboo spine'

U Aggarwal, A Kumar, A Agarwal, A Sharma, K Gupta; Department of Rheumatology, Fortis Flt Lt Rajan Dhall Hospital, New Delhi, India

Background: Vertebral fracture rates are very high in advanced AS. Spinal BMD measurement by DEXA in 'bamboo spine' usually gives invalid Results. Quantitative CT is not acceptable because of high radiation exposure. Femoral neck has been suggested as a possible surrogate site for measuring spinal BMD in AS. Spinal BMD measurement in AS remains an area of unmet need.

Objective: To study distal forearm and femoral neck as surrogate sites for measurement of spinal BMD using DEXA technique in patients with advanced AS with bamboo spine.

Methods: 25 patients with advanced AS who had bamboo spine (high mSASSS scores) and disease duration more than 10 years were subjected to BMD measurement by DEXA at femoral neck and distal forearm. Patients who were on steroids and had history of disorders of calcium metabolism were excluded.

Results: All 25 patients were males with a median age of 49 years and median disease duration of 13 years. Vertebral morphometric fracture (s) were present in 10 (40%). BMD at femoral neck revealed osteoporosis in 4 patients (16%) and osteopenia in 9 (36%). BMD at forearm showed osteoporosis in 10 patients (40%) and osteopenia in 9 (36%). Two patients had osteoporosis at both sites. Thus, DEXA scan at femoral neck and distal forearm together could detect osteoporosis only in 48% of patients with advanced AS.

Conclusion: DEXA scan at distal forearm was more sensitive than femoral neck in detecting osteoporosis (40% vs 16%) in patients with advanced AS. This also implies that osteoporosis in AS is not caused by immobility of spine alone. There is a systemic component to its pathogenesis.

PC0025: Long-term outcome of patients with seropositive palindromic rheumatism

K Gupta, A Kumar, U Aggarwal, A Sharma, A Agarwal; Department of Rheumatology, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India

Background: Palindromic rheumatism is a well-known syndrome of painful episodes of non-deforming mono/oligoarthritis involving large joints which resolve spontaneously within 48-72 hours. ACPA positivity in these patients has been used to predict its evolution into RA. Data from India on this entity are scant.

Objective: To study long-term outcome of seropositive patients with palindromic rheumatism

Methods: All seropositive (RF and/or ACPA +ve) patients diagnosed with palindromic rheumatism between April 2009 and March 2015 in our rheumatology clinic were recruited and their outcome was documented during the period July-August 2019. Telephonic interviews were carried out when necessary.

Results: Thirty seven patients were identified as per the inclusion criteria. Five were lost to follow up. Clinical details with outcome data were available on 32 patients (F:M = 24:8, median age =46 years). Of these 15 were positive for both RF and ACPA, 12 only for RF and 5 only for ACPA. RA (ACR-EULAR criteria) developed in 25/32 patients (78.1%). Of these, 21 developed RA within 5 years and 4 in 5-10 yrs. The median time to development of RA was 1 year. The development of RA was preceded by a period of 3-6 months of substantially increased frequency of episodes of arthritis. Correlation of serology with progression yielded interesting Results: and will be discussed. Three patients (9.4%) continued to have episodes of palindromic rheumatism. Four patients (12.5%) attained long-term remission.

Conclusion: Most patients with seropositive palindromic rheumatism progressed to RA with 50% doing so in the first year of follow up. Patients should be counselled and closely followed up for development of RA and timely start of DMARDs. At the same time, it is important to avoid starting DMARD therapy prematurely because a subset takes 5-10 years to develop RA.

PC0026: Clinical profile of granulomatosis with polyangitis in a southern tertiary care centre

S Nagmafarheen, P S Arulrajamurugan; Madurai Medical College, Madurai Medical College, India

Background: Granulomatosis with polyangiitis (GPA) formerly known as Wegener's Granulomatosis is an immunologically mediated small vessel vasculitis that is pathologically characterized by inflammatory reaction pattern like necrosis, granulomatous inflammation and vasculitis that occurs in upper and lowerrespiratory tracts and kidneys.

Objective: To study the clinical and laboratory profile of patients with Granulomatous Polyangitis

Methods: A retrospective analysis of the records of patients fulfilling the diagnostic Criteria for Granulomatosis with polyangiitis who attended a Rheumatology clinic over a period of 7 years from 2012 was done. Clinical, hematological, biochemical, immunological and histological profiles wereanalyzed.

Results: 8 patients, 4 males and 4 females with the age range of 22-57 years with mean age of 37 years were included. The duration of symptoms is between 1.5 months to 24 months. Purpura and scleritis were present in 6 patients each followed by arthritis and paranasal sinusitis in 5 each .3 had otitis media. Epistaxis, cough and hemoptysis in 2 each. Proximal muscle weakness was present in 2 patient and 1 had peripheral neuropathy. 1 had fever. 6 were positive for C ANCA. Hematuria, proteinuria, leukocytosis, elevated ESR, CRP and renal parameters were seen in one patient each. 4 had necrotizing granulomas in lung biopsies. Chest X ray revealed cavitation and nodules in 1. CT chest showing nodules in 3 followed by ground glass appearance, cavity, air space consolidation in 2 each.

Conclusion: There is an equal gender preponderance. Eye and skin involvement being the most common manifestations compared to other studies followed by musculoskeletal, upper airway and pulmonary features. C ANCA positivity seen in majority of patients.

Figure 1 Click here to view

PC0027: Predicting factors affecting the adherence and non-adherence of methotrexate in rheumatoid arthritis

Ravita Thakran, Lubna Khurshid, Anand N Malaviya; Department of Rheumatology, ISIC Superspeciality Hospital, New Delhi, India

Background: Methotrexate (MTX) is the first-line disease-modifying anti-rheumatic drug for the patients with RA . It is important to look for the factors that may positively or adversely influence the adherence so as to modify them, thereby increasing adherence to the anchor drug.

Objectives: 1) To determine the adherence rate to MTX therapy in patients with RA. 2) To identify factors that promote either adherence or non-adherence

Methods: A cross-sectional observational study of 200 patients on MTX for at least 6 months was conducted. The questionnaire comprising demographic details , disease duration, previous treatment , duration of MTX, current dose and number of doses of MTX missed were recorded.Disease activity was measured by CDAI at each visit. Non-adherence was defined as an omission of two or more prescribed doses of MTX in previous 4 weeks. Patients were asked for the factors that motivated their adherence as well as non-adherence to MTX.

Results: Non-adherence was found among 25 % of patients. Those lacking awareness regarding importance and long term need of drug , co-morbidities; lack of affordability, availability at the local pharmacy and family support, social myths were significant factors for non-adherence. Age, gender, level of education, duration of RA, current doses of MTX was not significantly different for adherent and non-adherent patients. Patients who were non-adherent had increased disease activity (CDAI). Good counseling and fear of disability were the strong predictor of adherence among the adherent group.

Conclusion: Various personal and social issues lead to non-adherence, but good patient's counselling can make a difference. As MTX is an anchor drug for the treatment of RA, adherence to it is important for good disease control and a better outcome. Thus, the rheumatologist and the rheumatology nurses can help improve drug adherence by knowing the factor(s) that affect noncompliance

PC0028: Short-term outcomes in reactive arthritis

Manoj Kumar, Prasanta Padhan, Sakir Ahmed; Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India

Introduction: Reactive arthritis(ReA) is a lower limb and large predominant spondyloarthritis that occurs after genitourinary or gastrointestinal infections. Some remit spontaneously while some can even proceed to ankylosing spondylitis. The literature on outcomes of ReA is limited.

Objectives: To find out the short term out comes of ReA.

Methodology: All patients meeting Braun criteria for ReA and having a follow-up of at least 6 months were included. Their current status was determined by telephonic interview and physical review of certain patients as required. Patients with inadequate follow-up data were excluded. Disease activity was measured by Bath Ankylosing Spondylitis Disease Activity Index(BASDAI) while quality of life was ascertained by the Health Assessment Questionnaire-Disability Index(HAQDI).”

Results: 43 patients [8(18.6%) females; median age 26(IQR: 19-34.5years)] were included. Median follow-up duration was 26 (IQR:15-62) months. 27(63%) had resolved, 12(27.9%) had a relapsing-remitting course, 4(9.3%) had persistent arthritis.10(23.8%) were in drug-free remission for more than 6 months. One patient had switched to homeopathy. 33 had received sulfasalazine, 2 methotrexate, and 13 had received at least one intra-articular steroid injection.10 refractory cases received anti-TNF agents of which 3 were continuing, 3 had switched to sulfasalazine and 4 were completely off drugs. 15 were currently on non-steroidal anti-inflammatory drugs, 3 on oral steroids(plus other drugs). In the 33 patients still on drugs, median BASDAI was 0.4(IQR:0-1.6) and median HAQDI was 0(IQR:0-0.15).

Conclusion: In our cohort, around one-fifth attained drug free remission. For the patients continuing drugs, there is good control of disease activity with good quality of life.

PC0029: Macrophage activation syndrome in SLE and Systemic onset JIA: Similar or dissimilar

R Naveen, Hafis Muhammed, Avinash Jain, Latika Gupta, Durga P Misra, Able Lawrence, Vikas Agarwal, Ramnath Misra, Amita Aggarwal; Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Background: Macrophage activation syndrome (MAS) is a serious complication in rheumatic disease. Fever and hyperferritinemia are common in systemic onset JIA and cytopenias are common in SLE thus recognizing MAS in them is a challenge. Hence, we compared clinical, laboratory parameters, various classification criteria for MAS, and its outcome in SLE and sJIA.

Methods: Clinical and laboratory data were extracted from clinician diagnosed cases of MAS with SLE/sJIA who were admitted between 2004-2018 at a tertiary care hospital. Percentage of patients satisfying Ravelli, International consensus, HLH 2004 and criteria proposed by parodi et al were calculated.

Results: Among 33 patients (18 females) with MAS 19 had SLE and 14 had sJIA. MAS was more likely to be the presenting manifestation of disease in SLE as compared to sJIA (p<0.05). There were no differences in the clinical features among these two diseases. EBV and CMV were identified in 2 patients each as the trigger for MAS.Patients with SLE had lower baseline TLC and platelet whereas patients with sJIA-MAS had significantly higher median CRP (p = 0.002), fall in TLC (p=0.012) and delta ESR/CRP ratio (p=0.02) and lower fibrinogen level (p=0.006). Neutrophil to lymphocyte ratio, Ferritin/CRP ratio and number of patients with Ferritin/ESR >80 were similar. Bone Marrow hemophagocytosis was seen in only in 30% of patients.Only 6/33 fulfilled HLH criteria but criteria meant for sJIA or SLE performed well for both diseases and majority of patients could be diagnosed using them. Treatment included steroids(100%), cyclosporine(30%), Tacrolimus(21%), cyclophosphamide(21%), etoposide(3%) and thalidomide(12%). Outcome was similar in both groups.

Conclusion: MAS is more likely to be presenting manifestation in SLE compared to sJIA. Though lab parameters are significantly different in MAS associated with SLE &sJIA, criteria meant for MAS in sJIA or SLE MAS performed equally well in both diseases.

PC0030: Comparison between diarrhoea associated reactive arthritis and urinary tract infection associated reactive arthritis

Sidharth Arora, Prasanta Padhan, Sakir Ahmed; Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India

Background: Reactive arthritis(ReA) is a spondyloarthritis that is triggered by gastrointestinal or Urinary tract infection (UTI) infection. It has not been explored if there is a difference between post diarrheal ReA and post Urinary Tract Infection ReA.

Objective: To explore the difference between post diarrheal ReA and post UTI ReA.

Methods: All patients meeting the Braun criteria for ReA were included. They were divided into two groups (post diarrheal ReA and post UTI ReA) based on patient interview. Clinical features, laboratory and necessary laboratory analyses were collected in a preformed proforma. Appropriate statistic tests were used to compare the data. Data is mentioned as median (IQR).

Results: 67 patients [12 (17.9%)females; median age 25 (IQR:19-38) years] with post diarrheal ReA and 22 patients[16 (72.7%); median age 28 (IQR20- 32) years] with post UTI ReA were included. Proportion of females was statistically more in post UTI ReA (p<0.001). Duration of disease between the two were comparable [post diarrheal ReA 3 (IQR1-38) years; post UTI ReA 3 (1-24) years; p=0.76]. There was no difference in educational status. Clinical features were comparable between the two groups. [Table 1]

Table 1 Click here to view

Conclusion: Post UTI ReA was more common in females. However, in other parameters there was no difference between post diarrheal and post UTI ReA.

PC0031: Clinical outcome after lowering the dose of TNF alpha blockers among spondyloarthritis study

Kattel Vivek, Agrawal Yamuna¹, Tilwee Virend, Gupta Neetu², Malviya Sourabh; Medanta Superspeciality Hospital,³MGM College, Indore, Madhya Pradesh, India,¹BP Koirala Institute of Health Sciences Dharan, Nepal

Introduction: TNF alpha blockers are the most effective drugs against Spondyloarthritis (SpA). Recommended dose schedule by ACR and EULAR is associated with better clinical outcome however with higher cost, more risk of latent infection activation and increased likelihood of antibodies development against biological DMARDs (bDMARDs).

Objective: To study the effectiveness of low dose bDMARDs by increasing the gaps between two doses in Indian subcontinent.

Methods: It was a prospective study carried among 50 SpA patients for 52 weeks. SpA was diagnosed according to Assessment in SpondyloArthritis international Society (ASAS) criteria. Initially ACR recommended dose of Adalimumab or Eternacept was given for 12 weeks. Among patients with clinical remission 25% dose of the bDMARDs was reduced after every 12 weeks by increasing gaps between two injections. The dose reduction by 25% was further continued every 12 weeks among patients who had clinical remission.

Results: The median age was 36 years. Clinical presentation as low back pain, peripheral arthritis, enthesitis, dactylitis and uveitis was noted in 92%, 68%, 62%, 18% and 12% respectively. The baseline mean BASDAI, mean sobers and CRP were 7.2, 4.1cm and 29mg/L. By the end of 52 weeks 49 patients were on bDMARDS with mean BASDAI, mean sobers and CRP were 3.6, 6.9cm and 7mg/L. The effectiveness of bDMARDs was maintained among 100%, 98%, 96% and 90% at 24, 36, 48 and 52 weeks respectively despite of lowering the dose by 25% every 3 monthly. Flare ups were observed among 1, 3, 4, 6 and 9 patients at 12, 24, 36, 48 and 52 weeks interval of the treatment respectively.

Conclusion: Increasing gaps between two doses of bDMARDs under clinical supervision among SpA can be a cost effective option.

PC0032: Experience with the follow-up of patients at a rheumatology-clinic during the early years of practice

Anuj Shukla, Priyanka Gaur; Niruj Rheumatology Clinic, Ahmedabad, Gujarat, India

Background: Patient follow-up is important in autoimmune diseases due to relapsing-remitting nature. Follow-up depends upon many factors such as disease severity, duration, patient-doctor communication, patient's financial health etc. Here, we reviewed our initial database to understand the pattern of follow-up and the reasons for the same.

Objective: To share the experience with follow-up of patients seen in a rheumatology clinic.

Methods: Basic information stored in the database was used to contact the patients on phone or were requested personal interview in the clinic. A questionnaire was used to gather information related to the diagnosis and follow-up of the patients. Regular follow up was defined as >6 months.

Results: The total number of patients entered in the database during July'16 to Aug'19 were 4682. Out of which, we contacted 53%(2471) patients while 47%(2211) patients were not contacted due to following reasons; 25%(1200)–degenerative or non-autoimmune diseases (with <3 visits), 9%(439)-missing or wrong contact details, 9%(432)-unanswered calls and 7%(330) having a single clinic visit.Out of 2471 contacted, 83%(2059) were under regular follow-up while 15%(393) stopped follow-up. Among regular follow-up group (n=2059), diagnosis was available for 56%(1171) patients. Out of which, 757-rheumatoid arthritis, 92-spondyloarthritis, 68-systemic lupus erythematosus, 33-idiopathic-inflammatory-myositis, 33-mixed connective tissue disease, 13-primary Sjogren syndrome, 15-primary systemic vasculitis, 11-systemic sclerosis and 32-juvenile autoimmune diseases.Among the lost to follow-up group (n=393): 34%(136) informed got cured (>1year), 16%(63) had no reason, 14%(57) continued medicines but stopped follow-up, 12%(50) were seeing other allopathic doctors, 9%(39) opt for alternative medicines, 8%(34) stopped all medicines although symptomatic, 3%(13) were out of country or financial issues.

Conclusion: This is our initial effort to understand the follow-up of rheumatology related patients. We look forward to further study the factors influencing the follow up of patients. This can help in improved follow-up and better outcome of these patients.

PC0033: Clinical features, management and follow-up of myositis patients seen at a rheumatology clinic

Anuj Shukla, Priyanka Gaur; Niruj Rheumatology Clinic, Ahmedabad, Gujarat, India

Background: Myositis is a rare manifestation of various systemic autoimmune diseases. Its classification and association with myositis specific auto-antibodies (MSA) is evolving in the recent years. Here we share the experience with these patients in our early years of clinical practice.

Objective: To share the experience of patients presenting with the clinical features of myositis.

Methods: A data was collated using clinical notes and personal interviews of the patients seen from July2016 to June2019. Diagnosis of various Idiopathic inflammatory myositis was made based on EULAR-ACR Classification criteria 2017. MSA were tested using Immunodot Myositis12 SAE-IgG 12antigen kit or EUROLINE Autoimmune-Inflammatory-Myopathies 16Ag(IgG) kit in a private diagnostic laboratory.

Results: 41-patients presented with the clinical features of myositis. Mean age at disease onset was 37+14years and the disease duration was 9+4months. Sub-groups of the patients and their MSA profile are shown in [Figure 1]. Among clinical features: 90%(n=37) had muscle weakness, 68%(n=28) skin rash, 56%(n=23) arthritis, 29%(n=12) fever, 14%(n=6) ILD and 19%(n=8) had dysphagia and 21%(n=9) patients had Raynaud phenomenon.Mean follow-up duration was 16+13months. DMARDs used were methotrexate 68%(n=28), azathioprine 21%(n=9) and mycophenolate mofetil 2%(n=1). Rituximab, intravenous immunoglobulin and methylprednisolone pulse were used for induction in 12%(n=5), 4%(n=2) and 12%(n=5) patients respectively.Out of 41 patients, 4(9%) expired, 23(56%) are in remission, 2(4%) has active grumbling disease and 6(14%) patients are on induction therapy. 2 patients had pregnancy during follow up with successful outcome. Complications seen were infections 17%(n=7), calcinosis 9%(n=4), cataract 4%(n=2), hyperpigmentation 4%(n=2) and depression 2%(n=1).

Figure 1: Sub-groups of the myositis patients (N = 41) and myositis specific antibodies Click here to view

Conclusion: Thus, we collated a data of patients presented with myositis. The sample size is small for firm Conclusion. But data being from a single center, helped us to collect data uniformly and finely. In future, we look forward to continue collecting the data that might help clearer Conclusion.

PC0034: Prevalent vertebral fractures incur high risk of future fractures in inflammatory myositis

Sujata Ganguly, Able Lawrence, Ramnath Misra, Latika Gupta; Department of Clinical Immunology, SGPGI, Lucknow, Uttar Pradesh, India

Objective: To assess accrual of new vertebral fractures (VF) in patients with inflammatory myositis over 3 years.

Methods: 100 patients previously enrolled for a cross-sectional study on prevalence of asymptomatic VF were requested to review with repeat dorso-lumbar X-ray's and Bone mineral Density evaluation 3 years after the initial assessment and scored using Genant's semi-quantitative technique by two independent observers. Involvement of new vertebra, worsening of prior fracture or new site of fracture were recorded as “fracture event”.Clinical and disease variables were recorded. Statistical analysis was done using SPSS Version 23.

Results: Radiographs from 31 patients (8:23: M:F) of median age 38 years were reviewed. Eighteen of the 31 (58.06%) had VF at baseline.At 91.62 patient years of follow-up, fourteen of 18 (77.78%) patients with previous VF had new fractures, while one without previous fractures had new fractures. Total number of fractures (30 to 51) increased. Most had >1 fracture (14 of 19,73.6 %) although maximum (35 of 51, 68.62%) were grade 1 VF. The increase in lumbar fractures was greater than thoracic. (p=0.032). Previous VF conferred 9 times higher risk of developing a new VF (RR- 9.33(95%CI 1.40-61.95) p-0.02). Patients with old VF accrue fractures at a rate of 22.9 per 100 patient years of follow up. Of the 18 patients with DEXA scans, 3 had osteoporosis and 5 were osteopenic and 2 were below the expected range for age. Age and T scores at L4 level (r=-0.591, p-0.026) and lower third of radius (r- -0.653, p- 0.016) correlated with fracture number. Age, BMI and gender did not differ between fracture progressors and non-progressors nor did change in disease activity and Myositis Damage Index scores. (p-ns)

Conclusion: Patients with inflammatory myositis with prior asymptomatic VF have a high risk of subsequent VF irrespective of disease activity and glucocorticoids.

PC0035: Angiographic outcome in takayasu arteritis: A bidirectional study from a tertiary care hospital

K Spoorthy, D Phanikumar, N Ramakrisha, R Liza; Department of Clinical Immunology and Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Objective: Serial imaging studies recommended in monitoring Takayasu arteritis (TA) patients are not well documented.

Methods: In this bi-directional study, patients fulfilling the ACR 1990 criteria for TA, seen between January 2012 to May 2019 , with a follow up of at least 12 months and comparable CTA/MRA imaging at baseline and follow up were included. Demographic data, clinical features, angiographic and treatment details were noted. Angiographic details of narrowing, stenosis , wall thickening, wall enhancement , aneurysm ,dilatation were noted in 18 arteries in each patient (bilateral subclavian, common carotid, vertebral, right brachiocephalic, ascending aorta , arch ,descending thoracic and abdominal aorta, celiac, superior and inferior mesenteric artery, bilateral renal and common iliac arteries).

Results: Serial CTA / MRA imaging was available in 38 of 129 patients seen during this time. Median (IQR) duration from symptom onset to diagnosis was 18 (4.2-48) months and between two angiographic assessments was 14.5(13-24.2) months. Mean (SD) TADS available for 21 patients was 5(5.2). Establishing disease inactivity in clinically inactive patients was the most common indication for repeat angiogram (30/38).All received steroids. Methotrexate was initiated in 37 patients . During follow-up, no change in treatment noted in 28 patients. Two patients had radiographic progression in spite of clinically inactive disease. Type V was the commonest angiographic subtype (20/38) with abdominal aorta (27/38) and left subclavian artery (24/38) being most commonly involved. A change in type of angiogram was noted in 6 patients and 2 had improvement from type V to type IIa and IIb respectively.Data on 684 arteries assessment is mentioned below .

Conclusion: Wall thickening was the commonest abnormality at baseline and increased during follow-up . There was no significant damage accrual during therapy. Clinical follow-up is a reasonable tool for follow-up in patients with TA on therapy.

Table 1 Click here to view

PC0036: Evaluation of wrist joint and hand joint by ultrasonography in patients of rheumatoid arthritis and its clinical comparison

S Nelson, N Repaka, A Mittal; NSCB Medical College, Jabalpur, Madhya Pradesh, India

Background: Early diagnosis and treatment of rheumatoid synovitis can turn down the progression of rheumatoid arthritis (RA). However, in the early stages, patients may only have non-specific musculoskeletal symptoms. Ultrasound (US) is increasingly being used to evaluate joint involvement in RA.

Objective: The study aims to evaluate wrist and hand joint involvement in RA by US and its comparison with clinical examination, disease activity and illness duration

Methods: Patients with RA were subjected to detailed clinical examination and laboratory investigations. Ultrasonography of bilateral wrist and hand joint of both hands as well as at the level of carpal tunnel to determine median nerve diameter was performed. The Disease activity score (DAS28) was also calculated for all patient.

Results: Total 30 patients (25 females and 5 males) with 60 wrist and hand joints were evaluated. Sensitivity of ultrasonography for detecting periarticular changes in left wrist joint was calculated to be 83.33% and that of clinical examination as 58.8% while in case of right wrist joint sensitivity for ultrasonography was 81.81% and for clinical examination was 64.3%.The prevalence of carpal tunnel syndrome was found to be 25% amongst 60 wrists joint examined by USG with 95% CI: 14.8-37.8.On ultrasonography most common pathological abnormality on left wrist joint was erosion of carpal bones and on right side was synovitis of carpal bones. Most common pathological changes were synovitis in bilateral hand joint.The cases with high Das 28 score had higher significant pathological periarticular involvement in bilateral wrist and hand joints in comparison to one with low DAS 28 score.

Conclusion: Ultrasonography is more sensitive than clinical examination for detecting periarticular changes in bilateral wrist and hand joint. There was significant association between ultrasonography changes in bilateral wrist and hand joint and disease activity as well as duration of illness.

Figure 1: USG showing erosion of metacarpophalangeal joint Click here to view