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Patients with active rheumatoid arthritis (RA) frequently show an atherogenic lipid profile, which has been linked with the inflammatory reaction. Inflammatory cytokines, and particularly tumor necrosis factor-alpha (TNF-α), are implicated in the pathogenesis of both atherosclerosis and RA, and also involved in the development of the impaired lipid profile detected in active RA. Although anti-TNF-α agents have been proven effective in controlling joint damage and systemic inflammation, controversy remains about the effect of these drugs on the lipid profile; therefore, the aim of our study was to investigate the effect of anti-TNF-α treatment, in combination with disease-modifying anti-rheumatic drugs (DMARDs) and corticosteroid therapy, on the lipid profile of patients with active RA. Our data suggest that the combination anti-TNF-α/DMARDs/steroids do not significantly interfere with the lipid profile of RA patients. However, analysis of clinical response data showed that patients achieving low disease activity or remission seem to have a protective lipid profile, suggesting that better control of inflammation and disease activity can affect lipid metabolism. The available evidence indicates that high inflammation interferes with lipid metabolism, whereas good control of the chronic inflammatory state may positively influence the lipid profile and cardiovascular risk. Low cholesterol levels at baseline could predict a favorable outcome with anti-TNF-α treatment, but these data need to be confirmed by large prospective studies with long-term follow-up.

The so-called papular-purpuric gloves and socks syndrome (PPGSS) is a condition characterized by acute onset of intense erythema, edema and petechiae with a typical localization on the hands and feet, besides mucosal lesions of the oral cavity. The syndrome has a favorable and self-limited course, requiring only a symptomatic therapy. In the 50% of the cases described in literature (ninety cases in 22 years), is documented an acute infection caused by parvovirus B19 and in only two cases the onset of PPGSS is reported among different members of the same family. The aim of the work is to describe two cases of PPGSS arisen during a short time period in two family members affected by an acute parvovirus B19 infection found by serum sampling. The peculiarity of the study was the infrequence of the syndrome and the rareness of the description of PPGSS in rheumatology. This syndrome is usually described in dermatology, but it is also interesting for the rheumatologist because it comes in differential diagnosis with various autoimmune diseases.

Shigella flexneri is an emerging pathogen in men who have sex with men (MSM); recent outbreaks related to sexual practices have been noted in this population in the UK and other developed countries. While the majority of cases of shigellosis present with gastroenteritis, some vulnerable patients with underlying immunosuppression can develop complications like bacteraemia and may present atypically as an acute surgical emergency. This case report highlights such a case of S. flexneri bacteraemia in a man who had sex with men.

Erasmus syndrome is defined as the association of silica exposure and subsequent development of systemic sclerosis. The limited number of cases reported in the literature mainly involves miners and only sporadically other professionals. We describe a case of Erasmus syndrome in a marble worker. A 68 year old man came to our observation complaining pelvic and scapular girdle pain, evening fever, intense weakness and emaciation for about 1 month. He also reported to have had Raynaud’s phenomenon in his hands for the last 13 years. Also, his occupational history revealed a chronic exposure to silica dust. The patient presented pain in his shoulders and hips, moderate skin thickening and sclerosis in his hands and fingers extending proximally to his wrists. The diagnosis of systemic sclerosis was determined according to his clinical and medical history, the positivity of anti-Scl 70 antibodies, the nailfold capillaroscopy suggestive of an active scleroderma pattern and the detection of a mild restrictive pulmonary syndrome. The evaluation of the organbased complications excluded a gastroenterological and cardiovascular involvement, while the chest computed tomography (CT) detected multiple small nodules with a mantle distribution and enlarged lymph nodes with no signs of interstitial lung disease and fibrosis. Additional tests (positron emission tomography-CT, flexible bronchoscopy and broncho-alveolar lavage) excluded infectious diseases and cancer. However, given the pulmonary involvement, we performed a histological examination of the parenchyma and lymph nodes, which revealed a picture of pneumoconiosis. In the end, the occupational history and the findings from the diagnostic procedures led to the diagnosis of pulmonary silicosis. The precise definition of the pulmonary involvement was essential to the therapeutic approach to this patient.

Acute respiratory infections (ARI) are one of the most important causes of death in children. Human metapneumovirus (HMPV), a virus first described in 2001, has now been detected in almost all continents. HMPV causes bronchiolitis and pneumonia with a clinical spectrum similar to respiratory syncytial virus (RSV). We describe the incidence of HMPV and RSV during two consecutive seasons with a high incidence of ARI in Aracaju, Brazil. HMPV was responsible for 24% of cases of bronchiolitis in the 1st season (April-May 2002) but was not found in the 2nd year (April-May 2003). RSV was recovered from 61 (55%) children with ARI in 2002 and from 72 (68%) in 2003. Children with RSV bronchiolitis in 2002 had more hypoxia but less wheezing than in 2003. The incidence of HMPV and RSV genotypes causing bronchiolitis varied between the years. Long-term prospective studies are required to better describe the epidemiology of these viruses in children.

Objective: To evaluate efficacy and safety of intra-articular therapy (IA) with infliximab (IFX), in patients with psoriatic arthritis (PsA) and refractory monoarthritis. Methods: Four male and 1 female aged from 25 to 71 years and disease duration from 1 to 25 years, affected by PsA (CASPAR criteria) were observed . All patients were treated with immunomodulators (methotrexate, leflunomide, cyclosporin A), 3/5 with concomitant steroids, 4/5 with NSAID’s. Only 1 patient were treated with IFX 5 mg/kg IV every 6 weeks. Before the IFX injection an amount of synovial fluid was aspired from the inflamed site and the anti-TNF injection was echographic guided. Patients were evaluated at regular intervals through clinical and echographic examination and retreated in case of flare. Results: At follow-up visit after 7 days, in all patients treated with the first injection was detected total regression of the inflammation and no new inflamed synovial fluid was observed; power doppler examination shows reduction of local vascularization. Two patients experienced full remission after 6 months and only one injection, 1 patient (arthritis of the wrist) was in remission after 2 injections (3 months of interval). In 2 patients with knee arthritis and important synovial hypertrophy good results obtained after the first injection were not maintained afterwards and second injection was ineffective: these patients were evaluated for surgical intervention. Conclusions: Local injections of IFX were safe and well tolerated in all patients. The efficacy in short term was observed in all cases; our supposition is that presence of synovial hypertrophy is cause of worsening.

BACKGROUND: We describe the identification of, and risk factors for, the single most prevalent Mycobacterium tuberculosis strain in the West Midlands region of the UK. METHODOLOGY/PRINCIPAL FINDINGS: Prospective 15-locus MIRU-VNTR genotyping of all M. tuberculosis isolates in the West Midlands between 2004 and 2008 was undertaken. Two retrospective epidemiological investigations were also undertaken using univariable and multivariable logistic regression analysis. The first study of all TB patients in the West Midlands between 2004 and 2008 identified a single prevalent strain in each of the study years (total 155/3,056 (5%) isolates). This prevalent MIRU-VNTR profile (32333 2432515314 434443183) remained clustered after typing with an additional 9-loci MIRU-VNTR and spoligotyping. The majority of these patients (122/155, 79%) resided in three major cities located within a 40 km radius. From the apparent geographical restriction, we have named this the "Mercian" strain. A multivariate analysis of all TB patients in the West Midlands identified that infection with a Mercian strain was significantly associated with being UK-born (OR = 9.03, 95%CI = 4.56-17.87, p65 years old (OR = 0.25, 95% CI = 0.09-0.67, p < 0.01). A second more detailed investigation analyzed a cohort of 82 patients resident in Wolverhampton between 2003 and 2006. A significant association with being born in the UK remained after a multivariate analysis (OR = 9.68, 95% CI = 2.00-46.78, p < 0.01) and excess alcohol intake and cannabis use (OR = 6.26, 95%CI = 1.45-27.02, p = .01) were observed as social risk factors for infection. CONCLUSIONS/SIGNIFICANCE: The continued consistent presence of the Mercian strain suggests ongoing community transmission. Whilst significant associations have been found, there may be other common risk factors yet to be identified. Future investigations should focus on targeting the relevant risk groups and elucidating the biological factors that mediate continued transmission of this strain.

Objectives The aim of this study was to evaluate into a cohort of patients assessed for sicca syndrome the prevalence of secondary Syogren9s syndrome (sSS) in patients affected by spondyloarthritis (SpA), considering SpA a possible cause of sSS. Methods We evaluated,from December 2009 to December 2014 a total of 221 consecutive patients affected by sicca syndrome for suspected Sjogren9s syndrome (SS), 208 females and 13 males aged between 23 and 89 years(mean age 50.94 years). Each patient underwent minor salivary glands biopsy, anti-nuclear antibodies detection, anti-Ro and anti-La antibodies detection, Schirmer test, salivary gland scintigraphy and anti-HCV serology. The acute phase reactants,the C3 and C4 complement fractions were also simultaneously evaluated and ultrasonography of both the parotid and submandibular glands was performed and assessed with the grading proposed by Salaffi et al. (range 0-4). The classification of the patients affected by primary SS (pSS) and sSS was made according to the American-European Consensus Group criteria considering SpA, arbitrarily, among the other diseases cause of sSS. The classification of the patients with SpA was made only on patients that meet the modified New York criteria or the CASPAR criteria or the Amor criteria or the ESSG criteria or the ASAS criteria for the axial or the peripheral spondyloarthritis. The statistical analysis was carried out using the Kolmogorov-Smirnov test to check the distribution, the Student9s t-test for the comparison between the groups and the χ 2 -test to compare the categorical variables and the proportions; a p value Results 141 patients were classified as affected by SS and in particular 84 with pSS and 57 with sSS; the data were inadequate in 80 patients for the definition of SS (46 patients with essential sicca syndrome and 34 with UCTD). 21 of the 57 patients with sSS were affected by spondyloarthritis (36.84%) and the SS resulted secondary to rheumatoid arthritis in 20 patients (RA; 35.08%). The two groups of patients, one with sSS and SpA and the other one with sSS and RA were not reporting substantial differences in the average age, sex and in the Schirmer test positivity (51,76±12,5 vs 47,60±15,9 years, p=0.35; 20/21 vs 18/20 females, p=0.5; 90.47 vs 90.00%, p=0.66); the anti-nuclear antibodies, the anti-Ro/anti-La antibodies, the anti-CCP antibodies and the rheumatoid factor detection (61.90 vs 90.00%, p>0.05; 14.28 vs 50.00%, p=0.016; 19.04 vs 75.00%, p=0.001; 9.52 vs 80.00%, p Conclusions Since SpA were considered a possible cause of sSS,these patients represent in our series 9.50% of all the patients assessed for sicca syndrome, 14.89% of the patients with SS and 36.84% of the patients with sSS.Comparing sSS-SpA patients and sSS-RA patients the only statistically significant differences resulted in the lower frequency of anti-Ro/anti-La antibodies, anti-CCP antibodies and rheumatoid factor positive detection in patients with SpA.The data reported suggest the evaluation of the sicca symptoms in patients with spondyloarthritis in agreement with other studies in the literature. Disclosure of Interest None declared

Background Golimumab has proven to be effective and safe in randomized clinical trials Go-Forward, Go-After, Go-Before and Go-More for Rheumatoid Arthritis (RA), Go-Raise for Ankylosing Spondlylitis (AS), Go-Reveal for Psoriatic Arthritis (PsA) for which patients have been accurately selected. Instead, data from Golimumab therapy in patients from daily clinical practice, where comorbidities, poly-therapy, severe clinical manifestations, systemic extra-articular involvement may influence drug effectiveness or safety, are still lacking. Objectives The scope of this multicentric spontaneous observational study is to evaluate the effectiveness and safety of Golimumab – the newest anti-TNFa monoclonal antibody – in unselected patients who are affected with chronic polyarthritis – RA and Spondyloarthritis (SpA) - and undergoing the treatment with Golimumab in 11 rheumatologic clinical Units of Apulia (Southern Italy). Methods 211 patients (69 males and 142 females) affected with polyarthritis (44 RA, 167 SpA, including 91 PsA and 76 axial-SpA) have been enrolled. Mean age was 50.5 (21-86) in SpA and 56.1 (21-81) in RA, with mean disease duration of 7 years in SpA and 9.31 in RA, respectively. Safety and effectiveness were established as primary end-points following 12 months for RA and 24 months for SpA. Effectiveness was assessed by 28-joints disease activity (DAS28), clinical disease activity index (CDAI) and Health Assessment Questionnaire (HAQ) in RA patients, whereas Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive protein Ankylosing Spondylitis Disease Activity Score (ASDAS) and DAS28 were used in axial-SpA and PsA. ANOVA for repeated measures has been used for statistical intra-group comparisons between baseline and different follow-up points. Results 8 patients out of 211 were lost during follow-up; 34 patients (16,7%) out of 203 interrupted Golimumab treatment due to inefficacy; 13 (6,4%) presented major side effects causing drug interruption; 5 (2,4%) showed minor side effects that did not demand the treatment interruption. Table 1 and 2 show treatment effectiveness. Conclusions Preliminary results confirm a good effectiveness and safety of Golimumab in patients with RA or SpA in standard care settings. Further analysis to assess the influence of obesity and other comorbidities, or combination therapy with standard drugs are ongoing. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1923

Objectives The persistence in therapy is an important assessment tool of therapy efficacy in patient with chronic disease. The aim of this study was to evaluate drug survival (DS) of a patients cohort suffering from chronic inflammatory rheumatism treated with abatacept. Methods From September 2008 to March 2013, we retrospectively observed a total of 107 patients starting therapy with abatacept, in a single center of southern Italy. They were 88 females and 19 males, aged between 21 and 85 years (54.65) and with disease duration between 2 and 45 years (11,71). 60 patients were suffering from rheumatoid arthritis (RA; 56.07%), 6 from chronic undifferentiated polyarthritis (5.60%), 2 from juvenile idiopathic arthritis (1.86%), 1 from Still9s disease (0,93%) and 38 (35.51%) from seronegative spondyloarthritis (SpA). 91.58% (98 patients) had also comorbidities. 18.69% of the patients (20 patients) were naive to the treatment with biological drugs. 77.00% of patients took DMARDs and 69,39% were receiving steroid. Results DS resulted averaging 15.40 months, retention rate after 1 year (RR1) was 49.53% and after 2 years (RR2) was 25.23%. Half of the patients (53 patients, 49.53%) interrupted the therapy during the observation period, mostly due to inefficacy or loss of efficacy (64.15%) and only 3.77% due to side effects. DS, RR1 and RR2 were clearly higher in patients taking DMARDs compared to patients taking abatacept in monotherapy (14.58 vs 11.26 months, p= ns; 50.64% vs 30.43%, p=0.038 and 24.67% vs 8.69%, p=0.042, respectively). The RA patients showed higher values of the examined parameters compared to the patients with SpA (DS: 17.31 vs 11.36 months, p=0.029; RR1: 53.33% vs 44.73%, p= ns; RR2: 33.33% vs 7.89%, p=0.0001). Considering patients in first-line vs patients in subsequent lines of biological therapy DS resulted 12.50 vs 16.06 months, RR1 45.60% vs 50.57% and RR2 20.00% vs 26.43%; this result could be justified by the shorter period of observation of patients in first-line of biological therapy, due to the more recent use of abatacept in patients naive to biological therapy. 80.00% of these patients resulted in fact still in therapy at the end of the observation vs 43.67% of the patients in subsequent lines of biological therapy (p=0.0001).The average value of DAS 28 and good or moderate EULAR response achievement appeared better in patients in first line of biological treatment (3.59 vs 4.04, p=ns and 63.16% vs. 46.57%, p=0.0228, respectively). Conclusions Into a cohort of patients with chronic inflammatory rheumatism and treated with abatacept DS was in line with the results reported in few studies on the subject. The persistence in therapy was better in patients with RA compared to patients with SpA and in patients treated with DMARDs compared with patients taking abatacept in monotherapy. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2669

Background Rheumatoid arthritis (RA) patients present increased mortality due to cardiovascular (CV) events, particularly by inflammation in addition to traditional CV risk factors (mainly changes in lipid profile). Although anti-TNF agents have been proven effective in controlling joint damage and systemic inflammation, nowadays there is still controversy about the real effect of anti-TNF treatment on the lipid profile. Objectives The aim of this study is to evaluate the evolution of the lipid profile after the onset of anti-TNF therapy. Methods Eighty RA patients (65 female, age 53±13 years, disease duration 7±5 years), who failed treatment with DMARDs, have been enrolled in this study, and evaluated, before and at 24 and 52 weeks from the start of anti-TNF treatment, for the following lipid profile: Total-cholesterol (Tot-C), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), triglycerides (TG), and cholesterol risk ratio (CRR) [Tot-C/HDL-C] was also calculated. At the same time the disease activity scores CDAI, SDAI, DAS44 and DAS28, four variables, were assessed. Twenty-nine patients were treated with etanercept, 19 with adalimumab, 18 with infliximab, 7 with certolizumab-pegol and 7 with golimumab. Results The levels of Tot-C, HDL-C, LDL-C and TG, as well as CRR, didn’t significantly changed during the follow-up period of treatment. Considering the disease activity according to CDAI, SDAI, DAS44 and DAS28, about 50% of patients achieved low disease activity/remission state after 24weeks and about 60% achieved this state after 52 weeks of treatment. In this latter group of patients we observed significantly lower levels of Tot-C, LDL-C, and TG, and a lower CRR compared to those observed in patients with moderate/high disease (see Table). No significant differences were found between the anti-TNF evaluated. Conclusions Our study suggest that anti-TNFα treatment per se do not interfere with the lipid profile of RA patients. While according to response to TNFα treatment, assessed by CDAI, SDAI, DAS44 or DAS28, patients that achieved low disease activity/remission seems to have a protective lipid profile for CV events, so a better control of the disease can also affect the lipid metabolism. Disclosure of Interest None Declared

Objectives TNFα is a key cytokine in the integrated host defence system against infectious diseases, acting on both the innate and the adaptive immune system. Anti-TNF agents may elicit Hepatitis B Virus (HBV) reactivation in patients with positive serology for HBV markers. Few data regarding the safety of these agents in the setting of chronic viral infections are available, and these are mainly based on case reports. According to our knowledge this is the first retrospective analysis on safety of certolizumab pegol in patients with previous HBV exposure. Methods Among 35 patients with rheumatoid arthritis treated with certolizumab pegol in a single center of the southern Italy, we identified 10 patients with previous documented HBV exposure, 2 male and 8 female with average age 55,5 years old; 8/10 resulted RF+, 4/10 RF+ and anti-CCP+. 8 were treated with DMARDs (6 methotrexate 10-15 mg/week, 1 cyclosporine A 150 mg/day, 1 idroxyclorochine 200 mg/day+ salazopyrin 1000mg/day) and 1 with mesalazine 800 mg/day. 9/10 were treated also with corticosteroids at low dosage (prednisone 2,5-12,5 mg/day, mean 5.5). 9 patients were HBsAg- and HBV serology was respective anti-HBs+ (8/9), HBeAg- (9/9), anti-HBe- (6/9), anti-HBc IgM- (9/9), anti-HBc IgG+ (6/9). 1 patient resulted HBsAg+, anti-HBs-, HBeAg-, anti-HBe+, anti-HBc IgM- and anti-HBc IgG+, and was on treatment with entecavir 0,5 mg/day since 3 years. Disease activity, inflammatory markers, transaminase levels, HBV markers and HBV-DNA where periodically monitored according to the local standard of care. Results Patients were monitored from 3 to 22 months (overall 110 months, mean 11 months). On this period none of the patients showed variation in HBV markers with stable anti-HBs titre (mean 761 vs 697mlU/ml); only 1 patient showed an increase in GPT ( Conclusions Into a cohortof patients with rheumatoid arthritis and treated with certolizumab pegol, 28.5% showed a previous contact with HBV. Therapy with certolizumab pegol showed to be safe although performed in combination with DMARDs and steroids and in the observation period HBV reactivation was not recorded in any patient. In one HBV inactive carrier patient the association therapy with certolizumab pegol and entecavir showed safety and efficacy for 12 months. Disclosure of Interest None Declared

Objectives This study aims to describe the sonographic abnormalities of the major salivary glands in patients evaluated for sicca syndrome. Methods 110 consecutive patients with sicca syndrome, 104 females and 6 males, aged between 23 and 81 years (mean age 50,9), were studied for suspected diagnosis of Sjogren’s Syndrome (SS). The classification of patients with SS was made according to the American-European Consensus Group criteria. Minor salivary gland biopsy was performed in accordance with the procedure proposed by Daniels et al and the histopathologic findings were evaluated through the Chisholm and Mason classification: the presence of at least 1 focus of mononuclear leukocytes in 4 mm 2 was considered positive (Daniels et al.). US of both the parotid and submandibular glands was assessed with the grading proposed by Salaffi et al.(range 0-4). Results 70 of the110 considered patients were classified as affected by SS (SS group: 4 males and 66 females, mean age 52,5, 41 with primary SS and 29 with secondary SS). In 40 patients the data were inadequate for the definition of SS (NSS group: 2 males and 38 females, mean age 48,2, 22 with undifferentiated connective tissue disease (UCTD) and 18 with essential sicca syndrome). Sonographic abnormalities (range 1-4) were found in 91,4% of the SS patients vs 75,0% in NSS group (p Conclusions The mayor salivary gland US in our experience, if considered by itself was shown to be a sensitive but nonspecific technique, very specific but less sensitive when considered in combination with histology or anti-Ro/anti-La antibodies positivity. The SS patients presented more often an advanced US grading than the NSS patients. Finally in the SS patients with positive histology or anti-Ro/anti-La antibodies positivity we frequently found a more advanced US grading. Disclosure of Interest None Declared

This study aimed to evaluate the incidence of influenza-like illness (ILI), from October 2009 to May 2010, in a group of patients suffering from chronic inflammatory rheumatism and treated with biological therapies. At the end of 2009-2010 influenza season, 159 patients under biological therapies answered to a questionnaire distributed 8 months before and were deeply interviewed. The group included 69 men and 90 women (mean age 47.6); forty-nine suffering from rheumatoid arthritis, 61 with psoriatic arthritis, 32 with ankylosing spondylitis and 17 with other spondyloarthritis; 146 patients were treated with anti-TNF-α, 7 with rituximab and 6 with abatacept; 128 patients assumed DMARDs and 72 patients assumed low dose of steroids. A case of ILI was identified by anamnestic findings and according to the case definitions commonly used in Europe. Seventeen percent of the considered population reported at least one episode of ILI during the monitoring period; none of the patients during the acute influenza attack suffered particularly severe symptoms and no one was hospitalized due to complications. Despite the diversity among the considered subgroups, the statistical analysis did not show any significant difference when incidence of ILI was considered for different disease, different biological agent and different association therapy. None of the examined variables resulted statistically significant concerning the relative risk evaluation. The incidence of ILI into a cohort of 159 patients treated with biological agents during the influenza season 2009-2010 resulted higher than the value reported in a wide sample of Italian population in the same period. However, the pandemic impact was not heavy among the studied patients, considering that no important complications or hospitalizations have been reported.