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Background:Mediterranean diet (MD) proved to be beneficial on disease activity in patients affected by rheumatoid arthritis. A few data are available in other rheumatic conditions.Objectives:A prospective monocentric study was conducted to evaluate the effect of a nutritional intervention based on the MD and to investigate the impact of such modification on disease activity of axial spondyloarthitis (ax-SpA).Methods:Patients affected by ax-SpA randomized to a nutritional intervention arm (N) or a control arm (C) and were assessed at baseline (T0) and at month 6 (T6). Patients in N underwent a nutritional evaluation and received suggestions for dietary modification at T0, and then every 2 months. Adherence to the MD was evaluated with the PREDIMED questionnaire (range 0-10) [1]. A multivariable regression analysis was conducted to identify independent predictors of PREDIMED and of ASDAS-CRP improvement at T6.Results:Eligible patients (161) were randomized to either N (81) or C (80); 47 in N and 63 in C completed the study. No relevant change of anthropometric or laboratory measures was observed at T6 in either group. A ≥20%PREDIMED improvement was more frequent in N (22/47, 46.8%) compared to C (13/63, 20.6%) (pConclusion:A nutritional intervention is effective in improving adherence to the MD in ax-SpA. A higher adherence to the MD may have a beneficial impact on activity of ax-SpA. Patients with psoriasis may have a limited benefit from the dietary improvement.References:[1]Martínez-González, M.A. et al. A 14-item mediterranean diet assessment tool and obesity indexes among high-risk subjects: The PREDIMED trial.PLoS One2012,7.Table 1.Characteristics of the patients.All patientsNutritionControlsAll patientsNutritionControlsBaselineMonth 6Females, n, (%)40 (36.4)18 (38.3)22 (34.9)Age, years, mean±SD51.7±1.353.0±1.349.6±1.3HLA-B27 positivity, n (%)58 (52.7)22 (46.8)37 (57.1)Psoriasis, n (%)58 (50.7)26 (55.3)32 (50.8)Disease duration (years), mean±SD15.3±9.715.7±1015±9.5Duration of b/tsDMARD treatment overall, years, mean±SD5±4.15.8±4.54.5±3.8NSAID, n (%)76 (69.1)30 (63.8)46 (73)csDMARD, n (%)14 (12.7)5 (10.6)9 (14.3)BMI, Kg/meters2, mean±SD26.5±5.426.5±4.326.6±6.126.4±5.326.3±426.6±6.1ASDAS-CRP, mean±SD2.1±12.1±0.92.1±12±1.11.8±0.92.1±1.2BASDAI, mean±SD37.6±2337.4±23.237.7±22.939.3±24.137.3±23.641.2±24.6BASFI, mean±SD20.5±21.421.6±19.219.7±2319.8±19.619.1±18.820.5±20.4BASMI, mean±SD1.6±21.9±2.21.4±1.71.8±2.11.9±2.41.7±1.9Tender joint count, mean±SD1.1±2.30.8±2.11.4±2.50.9±20.8±20.9±1.9Swollen joint count, mean±SD0.3±1.30.4±20.1±0.50.2±1.30.3±1.80.2±0.8Leeds Enthesitis Index, mean±SD0.2±0.80.3±10.2±0.61.1±21.3±2.21±1.8CRP, mg/L, mean ±SD3.4±6.23.2±3.93.7±7.43.5±5.62.6±3.14.1±6.9LDL-c, mg/dl, mean ±SD130.8±36.5132.3±35129.7±38.4130.6±34.7125.7±34.8134.4±34.5PREDIMED score, mean ±SD6.7±1.87±2.16.6±1.67.6±2.18.6±1.96.8±2b/tsDMARD biological/targeted synthetic DMARDs; csDMARD conventional DMARDs. PREDIMED questionnaire to assess adherence to the Mediterranean diet.Disclosure of Interests:None declared.

Post-traumatic arthritis (PTA) develops after an acute direct trauma to the joints. PTA causes about 12% of all osteoarthritis cases, and a history of physical trauma may also be found in patients with chronic inflammatory arthritis. Symptoms include swelling, synovial effusion, pain and sometimes intra-articular bleeding. Usually, PTA recoveries spontaneously, but the persistence of symptoms after 6 months may be considered pathological and so-called chronic PTA. A variety of molecular, mechanobiological and cellular events involved in the pathogenesis and the progression of PTA have been identified. The activation of inflammatory mechanisms during the PTA acute phase appears to play a critical role in the chronic disease onset. Human studies and experimental models have revealed that a series of inflammatory mediators are released in synovial fluid immediately after the joint trauma. These molecules have been proposed as markers of disease and as a potential target for the development of specific and preventative interventions. Currently, chronic PTA cannot be prevented, although a large number of agents have been tested in preclinical studies. Given the relevance of inflammatory reaction, anticytokines therapy, in particular the inhibition of interleukin 1 (IL-1), seems to be the most promising strategy. At the present time, intra-articular injection of IL-1 receptor antagonist is the only anticytokine approach that has been used in a human study of PTA. Despite the fact that knowledge in this area has increased in the past years, the identification of more specific disease markers and new therapeutic opportunities are needed.

Background Pain, physical function (PF) and quality of life (QoL) are important aspects of the lived experience of those with chronic disease1. Objectives A EULAR funded study to adapt the Osteoarthritis Quality of Life Scale (OAQoL) into five languages (German, Hungarian, Italian, Spanish, Turkish) gave the opportunity to explore the relationships between these key attributes in osteoarthritis (OA). Methods A Path Model was employed, within a Structural Equation Framework, utilising Rasch-transformed latent estimates as single indicator latent variables. Measures included lower & upper limb joint count (Manikin), pain on function (WOMAC), PF (HAQ) and QoL (OAQoL). The hypothesis was that the impact of pain upon QoL would be partially mediated by PF and this relationship will be invariant by age, gender and country. Results 677 patients with OA were recruited across 5 countries, approximately 20% from each. 76% were female, 33% aged 60 and under. 65% were married, 22% in work. Duration differed significantly across countries, with 10.1% of those in Turkey with duration of 15 years or more, compared with 32.5% of those in Spain. Joint count also varied significantly, e.g. 33.8% of those recruited in Spain reported no lower limb involvement compared with just 1.5% in Hungary. Path model fit was acceptable (χ2 7.52 (df 4) p=0.111; RMSEA 0.036; TLI 0.992, CFI 0.997) (Figure). All path weights were consistent with the basic hypothesis and 43% of the impact of pain upon QoL was mediated through PF (Sobel-Goodman Z 10.93; p 0.01) by age, gender, duration and, to a large extent, by country. In the latter there were slight variations in the magnitude of paths weights between pain and PF. The effect appeared much stronger in Italy and Turkey than elsewhere. Overall, the model appeared robust across countries (Model fit χ2 26.85 (df 20) p=0.14; RMSEA 0.05; TLI 0.985, CFI 0.993). Country-specific adjusted R2 for explained variance in QoL ranged between 0.59–0.71. Conclusions Pain, PF and the consequent reduction in perceived QoL are at the centre of the lived experience of those with OA. The relationship between these three variables, including the mediating role of PF, was found to be consistent across age, gender and, with slight variations, country. This “standard model” for OA opens up the opportunity to further explore potential psychological mediating factors which may improve QoL as well as moderating factors such as different types of intervention. References Parker L, et al. The burden of common chronic disease on health-related quality of life in an elderly community-dwelling population in the UK. Fam Pract 2014;31:557–63. Disclosure of Interest None declared

Concepts regarding osteoarthritis, the most common joint disease, have dramatically changed in the past decade thanks to the development of new imaging techniques and the widespread use of arthroscopy that permits direct visualisation of intra-articular tissues and structure. MRI and ultrasound allow the early detection of pre-radiographic structural changes not only in the peri-articular bone but also in the cartilage, menisci, synovial membrane, ligaments and fat pad. The significance of MRI findings such as cartilage defects, bone marrow lesions, synovial inflammation/effusions and meniscal tears in patients without radiographic signs of osteoarthritis is not fully understood. Nevertheless, early joint tissue changes are associated with symptoms and, in some cases, with progression of disease. In this short review, we discuss the emerging concept of early osteoarthritis localised to the knee based on recently updated knowledge. We highlight the need for a new definition of early osteoarthritis that will permit the identification of patients at high risk of osteoarthritis progression and to initiate early treatment interventions.

Background Takayasu arteritis (TA) is a chronic large vessel vasculitis of an unknown cause, affecting the aorta and its primary branches, that leads to wall thickening, stenosis and thrombus or anuerysm formation. Therapy consists of the administration of glucocorticoids (CS) but relapse or steroid dependence may lead to associate immunosuppressive agents to achieve remission and prevent new arterial lesions. The pathogenesis of TA includes vessel injury mediated by T cells, NK cells, γ/δ cells and macrophages that secrete pro inflammatory cytokines including TNF-α. Therefore TNF-α antagonist might be useful in TA therapy. Only few cases of the use of anti TNF-α agents in TA patients are reported to date. We report the medium and long-term efficacy and tolerance of TNF-antagonist Infliximab in 4 patients affected by TA refractory to conventional therapies Methods We evaluated 4 patients treated with anti TNF therapy (Infliximab) with a follow-up of 44.25±27.1 months (range from 7 to 72 months).The patients (all females) fulfilled the diagnosis of TA according to the ACR 1990 criteria. Their mean age was 23±3.3 years and mean disease duration was 67.75±78.03 months. All patients underwent detailed clinical examination and laboratory evaluation including complete blood count, ESR, CRP, chest radiograph, ECG, peripheral vascular Doppler and PET-CT. Disease activity was considered by clinical, biological and PET-CT features. All the patients were initially treated with high doses of CS (prednisone 1mg/kg/daily) and immunosuppressive drugs in order to gain a better control of the vasculitis and to rapidly reduce steroid administration. After 3 months patients presented poor respons to clinical and biological features and were dependent on high doses of steroid. Therefore we started with Infliximab 3 mg/kg. The dose was increased to 5mg/kg in all patients due to the temporary efficacy of 3 mg/kg. Results After 4 weeks all patients felt better and they did not complain of fever, carotodynia, tiredness or thoracic pain. Laboratory tests showed a rapidly decrease of CRP from 74.2±21.61 mg/l to 2.25±0.5 mg/l and an improvement of anaemia. After 1 year we were able to reduce steroids to 5 mg/daily and immunosuppressive drugs without disease relapse in three patients and tapered prednisone to 10 mg daily in the fourth. A new PET-CT was performed on all patients after 1 year of therapy with Infliximab and we observed the disappearance of arterial hypermetabolism in three patients. They continue to be treated with Infliximab every 8 weeks without clinical, biological and radiological evidence of recurrence of the disease Conclusions Infliximab demonstrated to be effective in TA in all the parameters reflecting disease activity. Nevertheless, we were forced to administer the dose of 5 mg/kg due to the temporary efficacy of 3 mg/kg. Three of our patients achieved clinical, radiological and biological remission, the fourth tapered the dose of CS and immunosuppressive drug. Using-2-deoxiglucose uptake, arterial hypermetabolism on PET scan disappeared in the remission patients. In all 4 patients, biological markers normalized. During follow-up, no side effects or reaction to the infusion were observed. Our data confirm efficacy and safety of Infliximab in TA therapy Disclosure of Interest None Declared