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Background Certolizumab pegol (CZP) is a PEGylated Fab9 fragment of a humanized anti-TNF antibody and it brings rapid improvement of the signs and symptoms of RA. Musculoskeletal ultrasound (US) has been proved to be useful at assessing synovitis precisely in patients with RA. There are few reports, however, that verify the early response to CZP in RA patients by US. Moreover, it remains to be ascertained whether early US assessment of synovitis can predict future clinical response in treatment with CZP. Objectives In the present study we investigate whether US is useful for predicting future clinical response to CZP in RA patients. Methods Twenty patients with RA were treated with subcutaneous CZP 400 mg at weeks 0, 2, 4 followed by 400 mg every 4 weeks or 200 mg every 2 weeks. The mean age of patients was 55.2 years old and the mean disease duration was 5.9 years. The mean disease activity at baseline (week 0) was 4.91 for 28-joint disease activity score (DAS28). Fifteen (75%) patients were naive to biologic agents. Seventeen (85%) and 9 (36%) patients were treated with methotrexate and glucocorticoids concurrently. At baseline and weeks 2, 4 and 12, US examination was performed at bilateral MCP, PIP, IP, and wrist joints. Gray-scale (GS) and pulse Doppler (PD) signal was recorded in each joint using semi-quantitative score (0 to 3). The sum of these scores obtained from each joint was used as GSUS and PDUS score. Results At weeks 0, 2, 4, and 12, mean GSUS score was 24.1, 20.4, 17.5, and 16.7, respectively. Mean PDUS score at weeks 0, 2, 4, and 12, was 14.6, 10.8, 10.8, and 9.9, respectively. Both GSUS and PDUS score were improved significantly as early as 2 weeks after treatment (p=0.031 and 0.011) and reduced by degrees during study period. At weeks 0, 4, 8, 12, and 24, mean DAS28 was 4.91, 3.61, 3.55, 3.50, and 3.05, respectively. DAS28 was significantly improved as early as 4 weeks after treatment (p 50% reduction in PDUS score from baseline (PDUS 50 response) at week 2. At week2, none achieved a >50% reduction of GSUS score from baseline, whereas 8 patients indicated a >20% reduction in GSUS score from baseline (GSUS 20 response) at week 2. There was a marked high responder rate (80%: 4 out of 5) in the patients showing PDUS 50 response at week 2. Similarly, the responder rate (88%: 7 out of 8) of the patients showing GSUS 20 response at week 2 was remarkably high and significantly higher than that (25%: 3 out of 12, p=0.020) of the patients without GSUS 20 response. Conclusions Early response to CZP was confirmed by US examination and the early assessment of synovitis by US is useful to predict future clinical response to CZP in patients with RA. Disclosure of Interest None declared

Background Achieving remission is essential for avoiding joint destruction and disability in patients with rheumatoid arthritis (RA). Tumor necrosis factor inhibitors (TNFi) therapies represent an important advancement in therapy for RA. However, there remains a proportion of patients who do not improve despite TNFi therapies. Recently, Terao et al. (1) analyzed the distribution of affected joints in the 28 joints in patients with RA and showed that RA patients can be categorized into three subgroups based on their affected joints (1: PIP joints dominant, 2: MCP joints dominant, and 3: large joints with wrist joints dominant). Nevertheless, it remains obscure whether these three subgroups were correlated with treatment response. Objectives To analyze the prognostic significance of data collected at starting TNFi, especially the distribution of affected joints, to predict remission in RA patients at week 16. Methods Data from 62 TNFi-treated patients with RA at the baseline were used as variables to predict remission. The disease status at the baseline and week 16 was assessed using the disease activity score (DAS 28) and patients achieving remission at week 16 were identified according to EULAR criteria (DAS 28 Results The patients were classified into 11 (18%) of PIPd group, 19 (31%) of MCPd group, and 32 (52%) of L-Wd group according to their affected joints. Univariate analyses revealed that patients who achieved remission showed significantly lower levels of DAS28, mHAQ, ESR, and CRP, and shorter disease duration than those without remission. It was also disclosed that patients in PIPd group were more likely to achieve remission than patients in MCPd group or L-Wd group. The baseline characteristics including concurrent use of MTX and/or GC, previous biologics therapy, tender joint count, and swollen joint count were not associated with response to TNFi. Among the baseline characteristics, lower levels of ESR and belonging to PIPd group were independently correlated with achievement of remission in multivariate analysis (p=0.012 and 0.028, respectively). Conclusions We suggested that RA patients predominantly affected with PIP joints were likely to achieve remission in response to TNFi. The distribution of affected joints could predict future response to TNFi in RA patients. References Terao C et al. PLoS One. 2013; 8: e59341. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1980

Background Bisphosphonates are the first-line therapy for osteoporosis treatment though the long-term persistence and adherence to bisphosphonates remain low (1-2). This medication noncompliance has serious consequences as it is associated with higher morbidity and mortality (3-6). Objectives To explore patient preferences for the osteoporosis medication, we performed a cross sectional survey. Methods A questionnaire for the persistence and adherence was distributed to all patients and the attending doctor, who treated osteoporosis in our university hospital, the university teaching hospitals, and the related clinics. The questionnaire was designed that one form contained information from both patients and the attending doctors. A total of 679 questionnaire out of 765 were completed, and the data were evaluated. The medication noncompliance was assessed, and Cox proportional hazards regression was used to estimate the association between treatment regimens and “forgetting to take a medication”. For subgroup analysis between young old ( Results 556 women and 83 men were enrolled; 30% of the patients were in the 80s and 46% were in the 70s. All patients assumed oral bisphosphonates. 66% of the patients were assuming weekly bisphosphonates, 24.4% were assuming monthly bisphosphonates, and 8.7% were assuming daily bisphosphonates. Interestingly, 42 patients answered to assume daily bisphosphonates while the attending doctor reported to prescribe the daily bisphosphonates to 78 patients. In the multivariate logistic regression model, compared with daily bisphosphonates, weekly bisphosphonates was significantly associated with “forgetting to take a medication” (odds ratio 2.01 [95% CI 1.10-3.65]; P Conclusions Weekly drug regimen was significantly associated with incompliance. Considering that less number of patients answered “hassle” for monthly drug regimen, monthly regimen can be the best for adherence among the three regimens. Less frequent dosing regimen was further required especially in young old generation. References Imaz et al.Osteoporos Int. 2010;21:1943–1951. Kothawala et al.Mayo Clin Proc. 2007;82:1493–1501. Ryg et al. J Bone Miner Res. 2009;24:1299-307. FitzGerald et al. J Bone Miner Res. 2012;27:1907-15. Gehlbach S et al. J Bone Miner Res. 2012;27:645-53. Cameron et al. J Bone Miner Res. 2010;25:866-72. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1628

Background Musculoskeletal ultrasound (MSUS) is useful in monitoring rheumatoid arthritis (RA) and is emphasized its high sensitivity for detecting synovitis and good correlation with clinical disease activity indices, such as Disease Activity Score (DAS28) and Simplified Disease Activity Index (SDAI). While power Doppler ultrasound (PDUS) is widely accepted for the precise assessment of synovial vascularity and the response to treatment, whether the usage of anti-rheumatic drug itself has an effect on PD signal in synovitis has been elusive. Objectives This study was undertaken to determine whether the usage of anti-rheumatic drugs correlate with the assessment of PDUS of synovitis in RA. Methods In this retrospective study, total 167 patients with RA were recruited. The patients had a mean age of 58.6 years (range 23-83) and a mean disease duration of 3.7 years (range 0.1-30.3). They were treated as follows: One hundred and five (62.9%) received non-steroidal anti-inflammatory drugs (NSAIDs), Sixty three (37.7%) received low-dose oral prednisolone (PSL), ninety nine (59.3%) received methotrexate (MTX), and thirty six (21.6%) received biologic agents. The clinical assessment parameters including DAS28, SDAI, and modified Health Assessment Questionnaire (mHAQ) as well as the usage of anti-rheumatic drugs were analyzed in this study. US assessment was performed at the bilateral wrists, MCP, and PIP joints. PDUS was graded semi-quantitatively (0 to 3) in each joint, and the sum of these gradings was estimated as PDUS score. The patient with scoring >1 for PDUS was defined as PDUS positive. The association among PDUS score, the clinical assessment parameters, and the usage of anti-rheumatic drugs was explored by multivariate linear regression analysis. In the group of patients in DAS28 remission, multivariate logistic regression analyses were performed with PDUS positive as dependent variables. Results The rate of the patients having DAS28 remission was 23.3% (39/167) and that of PDUS positive in the group was 48.7% (19/39). SDAI, mHAQ, and NSAID usage were independently associated with increased scoring of PDUS in multivariate linear regression analysis. The usage of the other anti-rheumatic drugs was not associated with PDUS score. Within the group of patients with DAS28 remission, only the usage of NSAIDs was independently associated with an increase of PDUS positive patient. Image/graph Conclusions NSAIDs usage may accelerate the PD signal and result in higher scoring despite continuing remission state. Consideration should be given to the NSAIDs effect in assessing disease activity of RA using MSUS, particularly during remission. Disclosure of Interest None Declared

Simple hepatic cysts are usually asymptomatic and are not associated with impaired hepatic function. However, complications, such as obstructive jaundice, rupture, intracystic haemorrhage and infection, can occur. The authors describe the case of a 82-year-old man with fever and elevated C-reactive protein. A repeat contrast-enhanced abdominal CT scan revealed enlargement with peripheral enhancement in the left lateral segment of the liver. A diagnosis of infected hepatic cyst was made, and percutaneous transhepatic drainage of the cyst was performed. When a patient has liver cysts and high-grade fever, liver cysts should be considered as a focus of infection. Repetition of ultrasonography and/or CT studies should be considered, even if no typical findings are obtained initially. It is of note that conventional Ga-scintigraphy may be useful for the detection of infected site.