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Objective To investigate metabolic syndrome (MetS), disease activity, and adipokine levels among patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and undifferentiated arthritis (UA) at the time of diagnosis and after 1 year of follow-up. Methods Patients with inflammatory joint diseases participating in the Northern Savo 2010 population-based prospective epidemiological study were evaluated for components of MetS (by National Cholesterol Education Program's Adult Treatment Panel III) and clinical parameters of disease activity. The adipokines adiponectin, adipsin, resistin, and leptin were measured at baseline and after 1 year of treatment with disease-modifying antirheumatic drugs. Results Among 176 patients, MetS was detected in 42% of RA, 36% of SpA, and 51% of UA patients. Metabolic syndrome was associated with higher disease activity as measured by patient global assessment in RA and UA patients and increased pain in RA patients. Leptin levels were increased in patients with MetS, showing a linearly increasing trend with the number of components of MetS in SpA and UA, but not in RA. In RA patients, decrease in disease activity correlated with decrease in leptin levels. Resistin did not associate with MetS, but a decrease in resistin correlated with decrease in disease activity in RA and UA. In SpA, increased adiponectin level correlated with relief in disease activity, but not with MetS. Conclusions Metabolic syndrome was common in patients with newly diagnosed arthritides and associated with higher disease activity and increased leptin levels. Resistin responded to treatment of arthritis in RA and UA, leptin in RA, and adiponectin in SpA.

Objective: We investigated lipid concentrations, particle sizes and antibodies binding to periodontal bacteria Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis and to malondialdehyde-acetaldehyde (MAA) modified low-density lipoprotein in immunoglobulin (Ig) class A, G and M among patients with newly diagnosed rheumatoid arthritis (RA) in a population-based cohort.Methods: Concentrations and sizes of lipoprotein particles analysed by proton nuclear magnetic resonance spectroscopy and antibody levels to MAA modified low-density lipoprotein were studied at baseline and after one-year of follow-up. Serum Ig A and G class antibodies to periodontal bacteria were determined at baseline.Results: Sixty-three patients were divided into tertiles according to disease activity by disease activity score with 28 joint count and erythrocyte sedimentation rate (ESR) ( 4.7). Small low-density lipoprotein concentration was lowest in the tertile with the highest disease activity. In high-density lipoprotein, the concentrations of total, medium and small particles decreased with disease activity. The particle size in low-density lipoprotein associated with disease activity and the presence of antibodies to P. gingivalis. Ig G and M antibodies to MAA modified low-density lipoprotein correlated with disease activity. Inflammation associated changes faded by one year.Conclusions: Drug naive RA patients had proatherogenic changes in lipid profiles, but they were reversible, when inflammation diminished.Key messagesPatients with drug naive rheumatoid arthritis showed proatherogenic lipid profiles.Reversible changes in lipid profiles can be achieved as response to inflammation suppression.Active therapy aimed at remission is essential in all patients with rheumatoid arthritis.

Backround Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension. Methods The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017–2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up. Results A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes. Conclusions During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline. Trial registration ClinicalTrials.gov Identifier: NCT02992431. Registered 14/12/2016

Objective To estimate the risk of mortality in the Finnish incident SLE cohort in a 16-year period compared with the general population. Methods Adults with new-onset SLE between 1 January 2000 and 31 December 2014 identified from the national drug reimbursement register and their individually matched controls from the Population Register Centre were followed up until death or 31 December 2015. Data on deaths were retrieved from the national causes of death register. Comorbidities and education were obtained by linkage to the other national registries. Results A total of 1006 patients with incident SLE and 3005 population controls were found (mean follow-up 8.6 years). Of these, 98 SLE patients subsequently died. Their 5 -, 10-, and 15-year survival rates were 95.0% (95% CI: 93.3, 96.2), 88.8% (86.2, 91.0), and 82.1% (77.6, 85.8), respectively. Crude hazard ratio (HR) was 1.61 (95% CI: 1.26, 2.06), adjusted for education level was almost the same 1.61 (95% CI: 1.26, 2.05). After adjustment for comorbidities and education at baseline, the difference in mortality disappeared: HR 1.14 (95% CI: 0.88, 1.48). The leading causes of death were cardiovascular diseases (CVDs) (33%), malignancies (27%) and neurological diseases (10%). Subhazard ratio for CVD deaths was 1.28 (95% CI: 0.85, 1.93), adjusted for comorbidities and education 0.88 (95% CI: 0.56, 1.39). Conclusions These results suggest that the increased mortality in SLE patients is highly associated with comorbidities present at diagnosis. This underlines the importance to screen and treat comorbidities and disease actively without delays.

Background: It is well established from a variety of studies that systemic lupus erythematosus (SLE) patients have a shortened life expectancy. The literature on SLE has highlighted the impact of cardiovascular diseases (CVD) on increased mortality 1,2. However, there is lack of studies comparing results to the background population. Objectives: Aim of the study was to clarify, whether incident SLE patients have an excess mortality compared to population controls. Methods: The study included all adult (age ≥ 17 years), incident SLE patients who were entitled to a special reimbursement for SLE medication in years 2000 – 2014 in Finland. For each patient, the Population Register Centre identified 3 population controls matched for age, sex and place of residence. Comorbidities at baseline were obtained from the Care Register for Health Care of the National Institute for Health and Welfare. Data on education at baseline and deaths until the end of 2015 were retrieved from the Statistics Finland. Results: A total of 1006 incident SLE patients (84% females) and 3005 population controls were found. During the follow-up (mean 8.6 years), 98 patients (mean age at death 70±14 years, 65% females) died. The 5 -, 10-, and 15-year survival rates in SLE patients were 95.0% (95%CI 93.3-96.2%), 88.8% (86.2-91.0%) and 82.1% (77.6-85.8%), respectively. The number of deaths among controls was 187. Crude hazard ratio (HR) was 1.61 (95% CI: 1.26 to 2.06), p Conclusion: SLE patients had a slightly increased risk for overall and cardiovascular related mortality compared to population controls. After adjusting for education and comorbidities, the difference was not statistically significant. References: [1] Bernatsky S, et al. Mortality in systemic lupus erythematosus. Arthritis Rheum 2006;54:2550-7. [2] Bjornadal L, et al. Cardiovascular disease a hazard despite improved prognosis in patients with systemic lupus erythematosus: results from a Swedish population based study 1964-95. J Rheumatol 2004;31:713-9. Disclosure of Interests: Pia Elfving Speakers bureau: Mylan Finland Oy, Abbvie Oy, UCB Pharma Oy Finland, Hannu Kautiainen: None declared, Lauri Virta: None declared, Oili Kaipiainen-Seppanen Speakers bureau: Boehringer Ingelheim, Kari Puolakka: None declared

Objective of the study was to evaluate the annual incidence and distribution of autoimmune connective tissue diseases and vasculitides during 2010. All units practicing rheumatology in the Northern Savo area, Finland, participated in the study by collecting data on newly diagnosed adult patients with autoimmune connective tissue disease or vasculitis over 1-year period. Seventy-two cases with autoimmune connective tissue disease were identified. The annual incidence rates were as follows: systemic lupus erythematosus 3.4/100,000 (95 % CI 1.4-7.0), idiopathic inflammatory myopathies 1.9 (0.5-5.0), systemic sclerosis 4.4 (2.0-8.3), mixed connective tissue disease 1.0 (0.1-3.5), Sjögren's syndrome 10.7 (6.7-16.1) and undifferentiated connective tissue disease 13.6 (9.0-19.6). The annual incidence rates among vasculitis category were as follows: antineutrophil cytoplasmic antibody-associated vasculitis 1.5/100,000 (95 % CI 0.3-4.3), central nervous system vasculitis 0.5 (0-2.7) and Henoch-Schönlein purpura 1.5 (0.3-4.3). The annual incidence of giant cell arteritis in the age group of 50 years or older was 7.5/100,000 (95 % CI 3.2-14.8). The longest delay from symptom onset to diagnosis occurred in systemic sclerosis. The incidences of autoimmune connective tissue diseases and vasculitides were comparable with those in published literature. The present study showed female predominance in all connective tissue diseases, excluding idiopathic inflammatory muscle diseases and mean age at onset of disease around 50 years of age. Despite improved diagnostic tools, diagnostic delay is long especially among patients with systemic sclerosis.

Background Immunization to biological drugs can reduce the treatment efficacy and increase the risk of adverse events. Objectives To determine the drug trough concentrations and anti-drug antibody (ADAb) levels of self-injected TNF-inhibitors, in non-selected patients with ankylosing spondylitis (AS) attending the rheumatological outpatient clinic, and to study the patient related factors affecting the immunization to antiTNF drugs. Methods A total of 313 patients with AS were recruited. A blood sample, taken 1–2 days prior to next drug injection, was obtained from 273 patients. Trough concentration of the anti-TNF drugs were measured with capture-ELISA (Promonitor EIA, Progenica), the levels of ADAb with radioimmunoassay (Sanquin Laboratories, The Netherlands), and the serum TNF-blocking capacity by using an in-house reporter gene assay. The clinical activity of AS was assessed using the Bath AS Disease Activity Index (BASDAI), the Bath AS Functional Index (BASFI), and the Maastricht AS Entheses Score (MASES). Results ADAbs were observed in 21% of patients on adalimumab (n=99), in 0% of those on etanercept (n=83), in 3% of those on golimumab (n=79) and in 50% of those on certolizumab pegol (n=12). The BASDAI in ADAb positive patients was 1.4 (sd 1.4) and in the ADAb negative patients 2.0 (sd 1.8 p=0.060). Factors affecting the immunization to biological drug could be further analyzed in patients using adalimumab. Trough drug concentrations of adalimumab correlated with the presence of ADAb (r=-0.54, rp Conclusions The disease activity of AS patients using self injected antiTNF drugs was low. The immunization to adalimumab was relatively common in nonselected AS patient population. However, no clear association was observed between the presense of ADAb and the disease activity. Acknowledgements The study was financially supported by Pfizer Disclosure of Interest J. Hiltunen: None declared, P. Parmanne: None declared, T. Sokka-Isler: None declared, T. Lamberg: None declared, O. Kaipiainen-Seppanen: None declared, P. Isomaki: None declared, M. Kauppi: None declared, L. Pirila: None declared, T. Uutela: None declared, R. Tuompo: None declared, H. Relas: None declared, T. Yli-Kerttula: None declared, H. Valleala: None declared, M. Romu: None declared, T. Rannio: None declared, K. Paalanen: None declared, A. Juha: None declared, P. Ekman: None declared, K. Tadesse: None declared, J. Borodina: None declared, P. Elfving: None declared, R. Peltomaa: None declared, M. Leirisalo-repo: None declared, H. Kautiainen: None declared, S. Jokiranta: None declared, K. Eklund Grant/research support from: Pfizer has supported the study financially, Consultant for: Advisory board meetings BMS, MSD, Pfizer, Abbvie, Speakers bureau: Lectures: BMS, Roche, Pfizer, Novartis

The objectives of the study were to investigate mortality and causes of death in patients with recent-onset systemic lupus erythematosus (SLE) in Finland. Data for patients with SLE for the study were collected (2000–2007) from the nationwide register on decisions of special reimbursements for drugs, maintained by the Social Insurance Institution (SII) in Finland. Data on deaths of the patients were obtained from the official death certificate statistics of Statistics Finland until the end of 2008. Of the 566 incident SLE patients, median follow-up time was 5.4 (IQR 3.3, 7.1) years, and 30 patients (23 females, seven males) died in the years 2000 through 2008. Mean age at death was 67.8 ± 17.2 years for females and 62.3 ± 15.2 years for males. The 5-year survival rates were 94.8% (95%CI 92.0–96.6%) and 88.2% (95%CI 76.5–94.3%), respectively. The age- and sex-adjusted standardized mortality ratio was 1.48 (95%CI 1.01–2.12). Primary causes of death were cardiovascular diseases, malignancy and SLE itself. In conclusion, survival of the patients with SLE was inferior to that of the general population. Cardiovascular diseases were responsible for 37% of deaths.

The aim of the study was to describe automated immunoassays for autoantibodies to homocitrulline or citrulline containing telopeptides of type I and II collagen in various disease categories in an early arthritis series.Serum samples were collected from 142 patients over 16 years of age with newly diagnosed inflammatory joint disease. All samples were analyzed with an automated inhibition chemiluminescence immunoassay (CLIA) using four different peptide pairs, each consisting of a biotinylated antigen and an inhibiting peptide. Assays were performed with an IDS-iSYS analyzer. Autoantibodies binding to homocitrulline and citrulline containing C-telopeptides of type I (HTELO-I, TELO-I) and type II collagens (HTELO-II, TELO-II) were analyzed.The mean ratio of HTELO-I inhibition in seropositive and seronegative rheumatoid arthritis (RA) was 3.07 (95% CI 1.41–11.60), p=0.003, and in seropositive and seronegative undifferentiated arthritis (UA) 4.90 (1.85–14.49), pAutoantibodies binding to homocitrulline or citrulline containing telopeptides of type I and II collagen did not differ significantly. They were highest among patients with seropositive disease and they differentiated seropositive and seronegative arthritis.

Interstitial lung disease (ILD) is a rare complication of methotrexate (MTX) treatment. It usually develops during the first 6 months of treatment but later occurrences have been described (1, 2). ...

The effect of intravesical Pasteur-F strain Bacillus Calmette-Guérin (BCG) on bladder carcinoma was studied in 39 patients. Multiple recurrent superficial transitional cell carcinoma was present in 36 cases, including 11 with concomitant carcinoma in situ (CIS), and primary CIS in three. The mean age of the 27 men and 12 women was 72 years. A 6-week induction course was given, beginning usually 4-6 weeks after transurethral tumor resection (TUR) or random biopsies, with periodic followup cystoscopies and cytologic analyses. A second 6-week course was given only to patients with incomplete response (positive urinary cytology or recurrent tumor). Three patients received maintenance intravesical BCG. If there was no response at the first cystoscopy after the induction course, no further BCG was given. Side effects were mostly local, moderate and transient, subsiding spontaneously or responding to symptomatic treatment. Severe systemic side effects occurred in three patients. Two with arthritis/arthralgia were managed as out-patients, while one with BCG pneumonitis/hepatitis required hospitalization, triple antituberculosis medication, cloxacillin and prednisolone. Complete response, defined as negative cystoscopy, cytology and histology, was obtained in 11 of 21 cases of papillary carcinoma without concomitant CIS. These patients were followed up for 8-47 months. Of the ten non-responders, two died and eight underwent further TUR. Of the 11 patients with concomitant CIS, six showed complete and five no response. Two of the latter died and three had further TUR. In all three cases of primary CIS there was complete response.

Background Aromatic and branched-chain amino acids and alanine have correlated positively, and valine, histidine and glutamine negatively with increasing levels of glucose. Those changes were at leat in part explained by insulin resistance. Insulin resistance is increased in inflammatory conditions like RA. Objectives To investigate amino acid metabolism (isoleucine, tyrosine, alanine, phenylalanine, leucine, valine, histidine, glutamine) among patients with newly diagnosed rheumatoid arthritis (RA) in a population based cohort. Methods For quantification of amino acids serum nuclear magnetic resonance platform operating at 500 MHz was used in native serum samples from patients with RA participating in Northern Savo 2010 Study. Correlations between age- and BMI-adjusted amino acid concentrations and patient reported general health (GH, VAS) were evaluated. The 95% confidence intervals for the correlations were obtained by bias-corrected bootstrapping (5,000 replications). Results Serum samples from 63 patients, 34 females and 29 males, with RA satisfying the ACR/Eular 2010 classification criteria were studied. The mean age (SD) of patients was 59.1 (12.0) years and the BMI (SD) 27.3 (5.4) kg/m 2 . 69.8% had anti-CCP antibodies. The mean DAS28 was 4.4 (1.3) and GH 52.7 (25.7). Correlations between age- and BMI-djusted amino acid concentrations and patient reported GH are shown in table. Phenylalanine, histidine and glutamine concentrations also correlated with CRP r=0.71, p Conclusions In untreated RA phenylalanine correlated positively with patient reported GH (higher disease burden) and CRP, whereas histidine and glutamine correlated negatively with them. In diabetes phenylalanine increased and histidine and glutamine decreased along with disturbances in glucose metabolism and in inflammation they may reflect inflammation associated insulin resistance. References Svenson KLG et al. Metabolism 1987;36:940–3. Soininen P et al. Analyst 2009;134:1781-5. Stancakova A et al. Diabetes 2012;61:1895-902. Disclosure of Interest None declared

Background Patients with rheumatoid arthritis have a higher energy expenditure than healthy controls. Released cytokines have thermogenic effect, which initially increases the metabolic rate. Insulin resistance is also increased in inflammatory conditions like RA. Objectives To investigate relationship between serum lactate and 3-hydroxybutyrate and patient reported outcomes: general health (GH,VAS) and pain (VAS), among patients with newly diagnosed rheumatoid arthritis (RA) in a population based cohort. Methods For quantification of lactate and 3-hydroxybutyrate serum nuclear magnetic resonance platform operating at 500 MHz was used in native serum samples from patients with RA participating in Northern Savo 2010 Study. Age-and BMI-adjusted correlation between lactate and 3-hydroxybutyrate with GH and pain were counted. The 95% confidence intervals for the correlations were obtained by bias-corrected bootstrapping (5,000 replications). Results Serum samples from 63 patients, 34 females and 29 males with RA satisfying the ACR/Eular 2010 classification criteria were studied. The mean age (SD) of patients was 59.1 (12.0) years and the BMI 27.3 (5.4) kg/m 2 . 69.8% had anti-CCP antibodies. The mean DAS28 was 4.4 (1.3), GH 52.7 (25.7), pain 56.4 (29.1), HAQ 0.70 (0.65), and GP 1.62 (0.29) mmol/L. The concentrations of lactate and 3-hydroxybutyrate were 1.46±0.27 mmol/L and 0.178±0.12 mmol/l, respectively. Age- and BMI-adjusted correlations for the concentrations of lactate and 3-hydroxybutyrate with GH and pain are shown in table. There were either no correlation between the concentration of lactate and CRP, or 3-hydroxybutyrate and CRP. Conclusions In untreated RA GH correlated positively with 3-hydroxybutyrate reflecting adverse influence of fatty acid metabolism induced ketogenesis on patients9 well-being. The finding also displays insulin resistance associated with RA. References Svenson KLG, et al. Metabolism 1987;36:940-3. Soininen P et al. Analyst 2009;134:1781-5. Disclosure of Interest None declared

Background Insulin resistance is increased in inflammatory conditions like RA. The glycosylation of the acute phase glycoprotein a-acid glycoprotein (AGP) in human sera is subject to marked changes during acute inflammation. Objectives To investigate relationship between glycoprotein acetyls (GP, mainly a1-acid glycoprotein) and patient reported outcomes: general health (GH, VAS), pain (VAS) and HAQ, among patients with newly diagnosed rheumatoid arthritis (RA) in a population based cohort. Methods For quantification of GP serum nuclear magnetic resonance platform operating at 500 MHz was used in native serum samples from patients with RA participating in Northern Savo 2010 Study. Crude and age-and BMI-adjusted correlation between GH, pain, HAQ and GP were counted. The 95% confidence intervals for the correlations were obtained by bias-corrected bootstrapping (5,000 replications). Results Serum samples from 63 patients, 34 females and 29 males, with RA satisfying the ACR/Eular 2010 classification criteria were studied. The mean age (SD) of patients was 59.1 (12.0) years and the BMI 27.3 (5.4) kg/m 2 . 69.8% had anti-CCP antibodies. The mean DAS28 was 4.4 (1.3), GH 52.7 (25.7), pain 56.4 (29.1), HAQ 0.70 (0.65), and GP 1.62 (0.29) mmol/L. GP correlated with CRP, r=0.79, p Crude and age- and BMI-adjusted correlations for GH/GP, pain/GP and HAQ/GP are shown in table. Conclusions In untreated RA glycation of proteins has adverse influence on patients9 welfare. References Svenson KLG, et al. Metabolism 1987;36:940–3. Soininen P, et al. Analyst 2009;134:1781-5. Disclosure of Interest None declared

Objectives To examine the first-year treatment of incident SLE. Methods The Finnish nationwide register data on special reimbursement decisions for SLE medication costs was screened to identify the inception cohort of adult SLE patient years 2000-2007. The cohort was shared in 2-year time periods according to index date. The patients were linked to prescription register, which includes drugs purchased from pharmacies. Both registries are maintained by the Social Insurance Institution. The first-year treatment of incident SLE was evaluated. Results A total of 566 subjects (87% females) were included in the incident cohort. Five percent of patients had not used any medicine and 80% had used some disease modifying anti-rheumatic drug (DMARD) during the first- year treatment. Prescriptions of mycophenolate mofetil as an initial treatment increased significantly throughout the time periods (2000-01, 2002-03, 2004-05 and 2006-07). Since year 2004 orally taken cyclophosphamide was not used in the first-year treatment of SLE. Conclusions Mycophenolate mofetil had a significant increasing trend in treatment of incident SLE during the study time. During the follow-up use of hydroxychloroquine and disease modifying anti-rheumatic drugs (DMARDs) was stable. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3086

Background Inflammatory joint diseases are systemic processes conveying an increased risk for cardiovascular (CV) diseases. The traditional risk factor profile does not explain the augmented risk in inflammatory joint diseases. Most work on CV risk evaluation has been done on established disease. We aimed to evaluate the occurrence of metabolic syndrome (MetS), a cardiovascular risk constellation, by using a simple and clinically applicable method, the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) definition of MetS, at diagnosis of and before any disease modifying treatment for, rheumatoid arthritis (RA), spondyloarthritis (SpA) and undifferentiated arthritis (UA), in a population based inception cohort. Objectives To investigate the occurrence of MetS among patients with newly diagnosed RA, SpA and UA. Methods Patients with inflammatory joint diseases participating in Northern Savo 2010 Study were evaluated for components of MetS according to the definition by NCEP-ATPIII. Results Two-hundred and two patients, 58 with RA, 69 with SpA and 75 with UA, were classified according to their metabolic condition. MetS was detected in half of the patients with RA and UA and in one third of patients with SpA. There were no differences between the sexes. Disease activity increased along with the number of MetS components in RA and UA, but the association was significant only in UA, p=0.021. Conclusions Metabolic syndrome is common already at diagnosis of inflammatory joint diseases. If this is a consequence of the insiduously progressing rheumatoid inflammation, or a risk factor in itself for rheumatic diseases, is an intriguing question. Nevertheless, metabolic syndrome contributes to the inflammatory activity of arthritis and efforts to influence the metabolic burden should be undertaken right from the beginning of treating early arthritis. References Chung CP, Oeser A, Solus JF, Avalos I, et al. Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis. Atherosclerosis 2008;196:756-63 Karvounaris SA, Sidiropoulos PI, Papadakis JA, et al. Metabolic syndrome is common among middle- to older-aged Mediterranean patients with rheumatoid arthritis and correlates with disease activity: a retrospective, cross-sectional, controlled study. Ann Rheum Dis 2007;66:28-33 doi:10.1136/ard.2006.053488 Sidiropoulos PI, Karvounaris SA, Boumpas DT. Metabolic syndrome in rheumatic diseases: epidemiology, pathophysiology, and clinical implications. Arthr Res Ther 2008;10:207. doi:10.1186/ar2397 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3112

Background Body composition is altered in inflammatory diseases, for example in inflammatory joint diseases, with less muscle mass and more adipose tissue. Metabolic syndrome (MetS) is an increasing global health issue contributing to the cardiovascular disease risk. Low grade inflammation through adipocyte derived adipokines is seen in MetS. Studies have been conducted to evalute the contribution of adipokines to the inflammation of rheumatic diseases and inherent cardioascular risk in established disease. Objectives To analyse adipokine levels in relation to MetS in patients with newly diagnosed, untreated rheumatoid arthritis (RA), spondyloarthritis (SpA) and undifferentiated arthritis (UA). Methods Patients with inflammatory joint diseases participating in Northern Savo 2010 study were evaluated for the presence of components of MetS according to the definition by National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). Adipokines adiponectin, adipsin, leptin and resistin were analysed from plasma samples by enzyme immunoassay. Results One hundred and seventy-six patients, 47 with RA, 58 with SpA and 71 with UA, were classified according to metabolic condition. When analysing the levels of adiponectin, adipsin, resistin and leptin in various arthritides with MetS present or absent significant differences in leptin in all diagnostic categories, in adipsin in SpA and in adiponectin in UA were recovered. Of the tested adipokines along with the fulfillment of 0-1 or 2-3 or 4-5 components of NCEP-ATP III adiponectin showed linear decrease in RA and in UA, p=0.037 and Conclusions Levels of the tested adipokines differed in various arthritis categories along with the metabolic condition suggesting that the inflammatory disease also contributes to the adipokine profiles in patients with rheumatic diseases. References Tilg H, Moschen AR. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat Rev Immunol 2006;10:772-783. Scotece M, Conde J, Gomez R, Lopez V, et al. Role of adipokines in atherosclerosis: interferences with cardiovascular complications in rheumatic diseases. Mediators of Inflammation 2012; Article ID 125458. doi:10.1155/2012/125458. Review Kontunen P, Vuolteenaho K, Nieminen R, Lehtimaki L et al. Resistin is linked to inflammation, and leptin to metabolic syndrome, in women with inflammatory arthritis. Scand J Rheuamtol 2011;40:256-262 Conde J, Scotece M, Lopez V, Gomez R, et al. Adipokines: novel players in rheumatic diseases. Discov Med. 2013;81:73-83. Review Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3615

Cytogenetic analysis of a transitional cell carcinoma (TCC) of the bladder, the tumor having developed 32 years after the patient received pelvic irradiation and interstitial radium implantation for an endometrial carcinoma, revealed the presence of 10 cytogenetically abnormal, unrelated clones. Although the tumor was poorly differentiated, all clones were pseudo- or near-diploid with rather simple balanced or unbalanced structural rearrangements or both. The chromosomes involved in structural changes more than once were chromosomes 8, 9, and 11, which were rearranged in three clones, and chromosomes 3 and 17, both rearranged in two clones. No previous TCC of the bladder with cytogenetically unrelated clones has been reported, nor has any such radiation-induced tumor with chromosomal abnormalities been described. The distinct karyotypic and clonal pattern of the case presented here is probably indicative of a carcinogenic field effect due to the previous pelvic irradiation. Postradiation bladder carcinomas thus seem to be distinct cytogenetically in addition to their known unique etiological and clinical features.

To evaluate the prognostic impact of cytogenetic findings in renal cell carcinoma (RCC).Tumour cytogenetics, histomorphology, DNA ploidy and S-phase fraction, stage, size, and grade were related to survival in 50 consecutive patients with RCC. The mean follow-up was 3.9 years (median 4.2, range 0-8.8).The predictive probability for recurrence-free survival at 5 years (5-year RFS) for all 50 patients was 0.54. There was a significant association between the degree of cytogenetic complexity and survival, in that patients with five or less aberrations had a better prognosis than those with more than five changes (5-year RFS 0.71 and 0.43, respectively; P0.05). Patients with del(8p)/-8, +12, and +20 had a significantly worse prognosis compared with those without these aberrations. Of the well-known prognostic variables grade and stage, the former was far better for predicting prognosis. A Spearman correlation test showed a significant covariation of grade with the S-phase fraction, T-stage, and cytogenetic complexity.The degree of cytogenetic complexity and recurrent cytogenetic abnormalities affect the prognosis in RCC, although grade was the most reliable independent prognostic factor predicting disease recurrence.

Background Trends in the incidence of RA may reflect changes in the host-environment relationship. Objectives To assess the incidence of seropositive rheumatoid arthritis (RA) during 30 year period in Northern Savo Finland and to evaluate the role of dental health on the incidence. Methods The incidence of seropositive RA was evaluated on the basis of epidemiological data collected from the previous and current studies in Northern Savo area from years 1980, 1990, 2000 and 2010. Serum samples from 134 and 175 arthritis patients were collected in two studies on inflammatory joint diseases in 2000 and 2010, respectively. As markers of periodontal disease serum immunoglobulin A (IgA) and IgG –class antibodies against Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) were determined in various diagnostic categories. Results A total of 196 subjects suffered from seropositive RA that had started at the age of 16 or over in 1980, 1990, 2000 or 2010. The incidence rate ratio of seropositive RA decreased in the age group of 35-54 years and increased in the older age groups. The levels of Aa and Pg antibodies did not differ between the diagnostic categories. In 2010, 66.7 % of patients with seropositive RA and 26.7 % of patients with seronegative RA showed elevated levels of PgIgA antibodies, p=0.014. The age, gender and diagnosis adjusted levels of AaIgA, PgIgA, PgIgG antibodies between years 2000 and 2010 showed significant decrease, P=0.011, Conclusions The declining trend for the incidence of seropositive RA occurred in the age-group of 35-54 years. Carriage of periodontal pathogens or a high prevalence of other infectious diseases may have influence on the risk of developing seropositive RA which could be reduced by public health measures. References Kaipiainen-Seppanen O, Kautiainen H. Declining trend in the incidence of rheumatoid factor-positive rheumatoid arthritis in Finland 1980-2000. J Rheumatol. 2006;33:2132-8. Disclosure of Interest None Declared

Objectives To evaluate the annual incidence and distribution of autoimmune connective tissue diseases (CTD) and vasculitides in a defined population in the Northern Savo during 2010. Methods All the units practicing rheumatology in the Northern Savo area participated in the study by collecting data of the new autoimmune connective tissue diseases and vasculitides diagnosed during a 1- year period. The population at risk was 206 000 and the patients were over sixteen years of age. Results Seventy-two cases with CTD were identified. Of them 78% were females. The annual incidence rates were as follows: Sjogren’s syndrome (SS)10.7, systemic sclerosis (SSc) 4.4, systemic lupus erythematosus (SLE) 3.9, dermato/polymyositis (DM/PM) 1.9, mixed connective tissue disease (MCTD) 1.0 and unspecified collagenosis 13.1/100 000. The mean age at diagnosis were in the patients with SS 48.9±15.3, SSc 65.1±9.9, SLE 46.2±14.8, DM/PM 68.7±10.4, MCTD 40.4±12.3 and unspecified collagenosis 50.1±14.0 years. Fifteen cases were classified as a vasculitis and included in 8 giant cell arteritis (GCA), 3 antineutrophil cytoplasmic antibody (ANCA) associated vasculitides, 3 small vessel vasculitides and 1 central nervous system (CNS) vasculitis. Females outnumbered males (10:5). The annual incidence rates among vasculitis category were as follows: GCA 3.9 (over 50 years of age), ANCA associated vasculitis 1.5, small vessel vasculitis 1.5 and CNS vasculitis 0.5/100 000. The longest delay from symptom onset to diagnosis performed in the category of systemic sclerosis. Conclusions The observed incidence rates compared to the earlier studies show that incidences of CTD and vasculitides have stayed unchanged during the time. Disclosure of Interest None Declared

Background Monitoring of the incidence of inflammatory joint diseases may provide new insight into the etiology of these diseases. Objectives All rheumatologists practising in the Northern Savo rheumatological outpatient departments collected data on their newly diagnosed patients with an inflammatory joint disease among patients over 16 years of age in 2010. Methods All rheumatologists practising in the Northern Savo rheumatological outpatient departments collected data on their newly diagnosed patients with an inflammatory joint disease among patients over 16 years of age in 2010. Results The incidence of all arthritis cases in the adult population was 142.0/100 000 (95% CI 126.2-159.2). The mean age at diagnosis for all patients with arthritis was 53.5±16.5 years. Sixty-nine patients, 38 men and 31 women, satis­fied the ACR 1987 classifica­ti­on criteria for RA. The incidence of RA by using the 1987 criteria was 33.4/100 000 (95% CI 26.0-42.3) and by the 2010 criteria 40.7/100 000 (95% CI 32.4-50.4) in the adult population. The incidence of RA for men and women according to the ACR1987 criteria was 37.6/100000 (95% CI 26.6-51.6) and 29.4/100000 (95% CI 20.0-41.7), respectively. The respective incidences among men and women in seropositive disease were 25.7 (95% CI 16.8-37.7) and 19.0 (95% CI 11.6-29.3) and in seronegative disease 11.9 (95% CI 6.1-20.7) and 10.4 (95% CI 5.2-18.7)/100 000. The incidence of undifferentiated arthritis was 47.5/100 000 (95% CI 38.6-57.9). This group included 13 (13.3%) cases with polyarthritis, 46 (46.9%) cases with oligoarthritis and 39 (39.8%) cases with monoarthritis. Of these 98 cases, 34 (34.7%) were male and 64 (65.3%) female. Twenty-eight (28.6%) were seropositive. In the spondyloarthritis group with 92 cases, the number of male and female patients was equal. The incidence of AS was 7.3 (95% CI 4.1-12.0), PsA 15.5 (10.6-21.9), ReA 7.3 (4.1-12.0), IBD associated arthritis 1.9 (0.5-5.0) and unspecified spondyloarthritis 9.7(5.9-15.0)/100 000. The incidence of gout was 11.6 (7.4-17.3) and calcium pyrophosphate arthritis 2.9 (1.1-6.3)/100 000 and the incidence of sarcoid arthritis and arthropathy in thyroid disease were 1.5 (0.3-4.3) and 0.5(0.0-2.7)/100 000. The mean age at diag­nosis was 62.6± 11.8 years for all patients with RA; 60.1± 10.5 years for men 64.2 ± 13.5 years for women, (p = 0.164). Fourty-six patients (66.7 %) had seropositive RA and 23 patients seronegative RA and there was no significant age difference between the groups, p=0.742. In patients with RF+ RA the peak incidence occurred in the age group of 55-64 years among men and 65-74 years among women. Conclusions In the present study the incidence of RF-positive RA was higher among men than among women. The peak incidence in men also occurred in the younger age-group than in women. The incidences of other inflammatory joint diseases were in accordance with earlier literature reports. References Savolainen E, Kaipiainen-Seppanen O, Kroger L, Luosujarvi R. Total incidence and distribution of inflammatory joint diseases in a defined population: results from the Kuopio 2000 arthritis survey. J Rheumatol. 2003;30:2460-8. Disclosure of Interest None Declared

In a multicentre study, 101 consecutive patients with advanced prostate cancer were offered the choice of orchiectomy or treatment with an LHRH analogue. Together with the cancer diagnosis the patients were given verbal information about the treatment alternatives, and detailed written information to peruse at home. One week later the patients informed the attending physicians of their choice. Information as to the reasons for the patients' choice, and their views on their choice after the start of treatment were elicited by questionnaire. Of the 101 patients, 48 chose orchiectomy, and 48 treatment with an LHRH analogue, five patients being excluded owing to their inability to decide. Mean age was about 73 years in both treatment groups, and about two thirds of each group lived with a partner. The level of education was higher among those who chose medical treatment. The predominant reasons for the choice of treatment were as follows: Orchiectomy, simpler (31 per cent), troublesome having to have monthly injections (19 per cent), simple to perform (15 per cent); medical treatment, possibility of change in treatment (27 per cent), simpler (17 per cent), fear of surgery (15 per cent). Most patients in both groups had no difficulty deciding, chose quickly, felt sure about their choice, appreciated the opportunity of choosing, and had discussed their choice with their partners or intimates. Three months after the start of treatment, almost all patients were still satisfied with their choice, and had no wish to change their choice even if that were possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Between 1980 and 1987, 54 patients with prostatic adenocarcinoma in stages T0 to T3, M0, underwent staging by pelvic lymphadenectomy, 16 with associated radical prostatectomy. Lymph node metastases were present in 28 cases (52%). In this study, the presence of pelvic lymph node metastases was better correlated to clinical stage than to histological grade.