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Objective: To investigate the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and clinical manifestations in patients with systemic sclerosis (SSc). Method: Th...

Rheumatoid arthritis (RA) is an inflammatory polyarthritis that typically affects the small joints but can also involve the manubriosternal joint (MSJ). Although cases of MSJ involvement in RA are rare, such cases present with chest pain, a mass-like lesion, and subluxation. These cases can also be diagnosed incidentally, while patients are asymptomatic. It is important to differentiate RA involving the MSJ from other diseases such as ankylosing spondylitis that can affect the MSJ. Several cases of RA affecting the MSJ have been reported in Western countries, but none have been reported to date in Asia, especially with disease activity of RA. Here, we report a case of RA in the MSJ that was confirmed by imaging and histological investigation in a middle-aged Asian woman.

Background Previous studies have reported that higher serum uric acid (SUA) levels are associated with higher bone mineral density (BMD) in men and postmenopausal women, and lower risk of fragility fracture in men. However, whether this association is also present in patients with rheumatoid arthritis (RA) has not yet been investigated. Objectives To examine the association of SUA levels with BMD and osteoporosis in postmenopausal women with RA. Methods We retrospectively evaluated 447 postmenopausal female RA patients (mean age 61.1 years) who underwent measurement of L1–4, femoral neck, and total hip BMD using dual energy X-ray absorptiometry, in addition to SUA levels at a university rheumatology centre in South Korea between 2004 and 2017. Osteoporosis was defined as a T-score of ≤−2.5 according to the World Health Organisation classification. Results The median (interquartile range) SUV level was 4 (3.3–4.8) mg/dL. The mean (±SD) L1–4, femoral neck, and total hip BMD were 0.93±0.16 g/cm2, 0.75±0.12 g/cm2, and 0.81±0.12 g/cm2, respectively, and the frequencies of osteoporosis in the spine, hip, and either site were 25.6%, 15.9%, and 32.5%, respectively. SUA levels were positively correlated with L1–4 (ρ=0.102, p=0.032), femoral neck (ρ=0.123, p=0.01), and total hip BMD values (ρ=0.146, p=0.002) and body mass index (ρ=0.231, p Conclusions Higher SUA levels were associated with a reduced risk of low BMD and osteoporosis at hip in postmenopausal women with RA, but no significant association between SUA levels and lumbar spine BMD was found. Our data suggests that uric acid may act as a protective factor against hip bone loss in RA patients. Disclosure of Interest None declared

Background Osteoporosis is a well-known extra-articular manifestation of rheumatoid arthritis (RA) and almost 2 times higher prevalence of osteoporosis was reported in female patients with RA than in healthy subjects. Accordingly, patients with RA are at increased risk of fragility fractures that lead to significant morbidity and mortality and higher healthcare cost. However, most previous epidemiologic studies regarding osteoporosis in RA have focused on female subjects, and little attention has been given to male patients with RA. Objectives To compare the prevalence of osteoporosis between male patients with RA and healthy subjects and to identify the risk factors of osteoporosis in male patients with RA. Methods By using a cross-sectional design, we recruited 76 male patients with RA aged 50 years and over and 76 sex-matched and age-matched healthy subjects at a university-affiliated rheumatology centre in South Korea from August 2014 to August 2016. We measured bone mineral density (BMD) at L1–4 levels of the lumbar spine and the hip (femoral neck and total hip) in all the subjects by using dual-energy X-ray absorptiometry (DEXA). We assessed the prevalence of osteoporosis defined as a T-score of ≤-2.5 according to the WHO criteria. We also investigated potential risk factors of decreased BMD and the presence of osteoporosis in male patients with RA using linear and logistic regression analyses, respectively. Results The mean age and body mass index (BMI) of the male patients with RA were 64.5 years and 22 kg/m2, respectively, which were comparable with those of the healthy controls. The overall prevalence of osteoporosis at either the spine or the hip in the male patients with RA was significantly higher than that of the healthy controls (22.4% vs 10.5%, respectively; p=0.049). However, no significant differences in the prevalence of osteoporosis at the spine (19.7% vs 10.5%, respectively; p=0.113) and the hip (3.9% vs 0%, respectively; p=0.245) were found between the patients with RA and the controls. For the male patients with RA, the median disease duration was 37 months, the mean 28-joint Disease Activity Score using erythrocyte sedimentation rate (DAS28-ESR) was 3.28 and the median modified total Sharp score was 6. An increased titre of anti-cyclic citrullinated antibody showed a trend toward lower L1–4 BMD (β=-0.0007, p=0.057) in the multivariable linear regression analysis. In addition, DAS28-ESR of >3.2 was independently associated with the presence of osteoporosis (OR=3.85, 95% CI=1.13–13.17, p=0.032) after adjusting for confounding factors. The patients with RA whose BMIs were ≤22 kg/m2 had a higher risk of osteoporosis (OR=3.43, 95% CI=1.04 -11.33, p=0.043). Conclusions Similar to their female counterparts, the frequency of osteoporosis in male patients with RA had an osteoporosis prevalence of about 2.1 times higher than that of the healthy subjects. Increased DAS28-ESR was an independent risk factor of osteoporosis. Our data suggest that appropriate management for osteoporosis in patients with RA is crucial not only for postmenopausal women, but also for men aged 50 years and over. Disclosure of Interest None declared

Background Epidemiologic studies have described clinical characteristics of patients with systemic lupus erythematosus (SLE) in Middle Eastern Asia and Western countries and marked ethnic and geographic differences in the prevalence, severity and outcome of SLE have been reported. However, data from Northeast Asia countries including South Korea are lacking. Objectives To investigate demographic, clinical, laboratory and immunological characteristics and prognosis of patients with SLE in South Korea. Methods We retrospectively evaluated 413 SLE patients (380 female, 33 male, mean age 40.6 years) diagnosed at 3 tertiary rheumatology centers in South Korea from 1992 to 2016 by reviewing medical chart. All patients fulfilled 1997 revised American College of Rheumatology classification criteria for SLE and were ethnically Korean. Results The mean (±SD) age at disease diagnosis was 30.9 (±12.8) years and the median (IQR) disease duration was 108 (60–168) months. The commonest clinical manifestations in our patients were arthritis (59.1%), fever (49.9%), malar rash (48.4%), alopecia (43.8%) and oral ulcer (35.1%). The frequency of major organ involvement was as follows: biopsy-proven lupus nephritis (40.7%), neuropsychiatric involvement (19.4%), secondary anti-phospholipid antibody syndrome (6.1%) and lupus pneumonitis (1.7%). Class IV (41.1%) was the most common type of lupus nephritis followed by class V (15.5%). Regarding hematologic abnormalities, the cumulative incidence of leucopenia was 74.3%, thrombocytopenia 46.5%, lymphopenia 45.1% and hemolytic anemia 8.7%. Antinuclear antibodies were detected in 97.8%, anti-Sm in 38.4%, anti-dsDNA IgG in 56.5%, anti-cardiolipine IgG in 27.4%, anti-cardiolipine IgM 11.8%, lupus anticoagulant in 23.2%, anti-Ro in 62.3%, anti-La 30.2% and anti-RNP in 47.9%. Twenty (4.8%) patients died during median follow-up of 84 months and the 5-year and 10-year survival rates were 96.9% and 95.5%, respectively (Figure 1). The major causes of death were infection (35%) and diffuse alveolar hemorrhage (20%). In multivariable Cor regression models, male (HR=8.68, p Conclusions Compared with data from other countries, the higher prevalence of hematologic manifestatons and positive anti-Ro antibody were prominent feature of South Korean SLE patients. Overall survival rate in our patients was better than that in other populations. References Khanfir MS et al. TULUP (TUnisian LUPus): a multicentric study of systemic lupus erythematosus in Tunisia. Int J Rheum Dis 2013;16:539–46. Al Arfaj AS et al. Clinical and immunological manifestations in 624 SLE patients in Saudi Arabia. Lupus 2009;18:465–73. Disclosure of Interest None declared

Background Fibromyalgia (FM) is related to the features of small fiber neuropathy (SFN). Sudoscan is a non-invasive device measures sweat gland dysfunction employing electrochemical skin conductance (ESC) and is useful for assessing peripheral small fiber nerve function. Little is known about the dysfunction of peripheral small fiber nerve in patients with FM. Objectives The aim of this study was to evaluate the prevalence and characteristics of SFN in patients with FM compared with a control group and to identify factors associated with SFN in FM. Methods 66 patients with FM (age: 53 ± 9 years old) to meet 2010 ACR preliminary diagnostic criteria and 66 healthy controls were enrolled. Each FM patient was required to fast 8 to 10 hours before blood samples. Serum fasting glucose, fasting insulin, Serum 25-(OH) D and the 75-gram two-hour oral Glucose tolerance test (GTT) were measured. Height and weight were measured and used to calculate Body mass index (BMI). Overt diabetes patients were excluded using their past and medication history. The small fiber neuropathy Symptoms Inventory Questionnaire (SFN-SIQ) was used to record neuropathic symptoms. Clinical assessments included fibromyalgia impact questionnaire (FIQ), Beck Depression Inventory (BDI), and The State-Trait Anxiety Inventory (STAI). All subjects underwent the examination of Sudoscan. Results The mean feet and hands ESC were significantly lower in the FM group than the control group.(table 1). Mean Hands ESC was irrelevant to age, BMI, SFN-SIQ, FIQ, fasting glucose, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and vitamin D and 2 hour GTT glucose level. However, Mean feet ESC showed significant correlation with fasting insulin (r= -0.34, p Conclusions Sudomotor function was significantly lower in patients with FM than the control group. Mean feet ESC was correlated with hyperinsulinemia and HOMR-IR in patients with FM, which implies that SFN associated with insulin resistance may play an important role in FM pain. References Neurophysiol Clin. 2015 Dec;45(6):445–55. Epub 2015 Nov 17. Diagnosis of small fiber neuropathy: A comparative study of five neurophysiological tests. Curr Pain Headache Rep. 2015 Dec;19(12):55. The Role and Importance of Small Fiber Neuropathy in Fibromyalgia Pain. Caro XJ, Winter EF Disclosure of Interest None declared

Background The incidence of hearing loss (HL) has been on the rise in patients with rheumatoid arthritis (RA). However, limited information exists regarding the pathogenic mechanisms of HL in RA patients1,2. Objectives This study sought to evaluate the prevalence and characteristics of HL in RA patients compared with a control group and to identify factors associated with the degree of HL in RA patients. Methods We enrolled 64 RA patients and 70 healthy controls in a prospective manner. Each subject was tested with pure tone audiometry including high frequencies ranging from 0.5 to 16 kHz. For each set of tests, mean values for air conduction at each frequency and tympanometric values were calculated to exclude middle ear disease. In the RA group, auto-antibodies, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and RA disease activity were measured, and carotid ultrasonography was performed for the detection of indicators of subclinical atherosclerosis, including arterial stiffness index beta (β-index) and carotid intima-media thickness (cIMT). Results The prevalence of HL was higher in the RA group than the control group (37.1% vs. 65.6%, p=0.001). The hearing threshold value difference between groups was significant at frequencies of 0.5, 1, 2, 4, and 8 kHz (p Conclusions HL was more prevalent in the RA group than the control group. cIMT and β-index were strongly correlated with HL in the RA group, which implies that subclinical atherosclerosis may play an important role in HL in RA patients. References Ozkiris M, Kapusuz Z, Gunaydin I, Kubilay U, Pirti I, Saydam L. Does rheumatoid arthritis have an effect on audiovestibular tests? Eur Arch Otorhinolaryngol. 2014;271:1383–7 Pascual-Ramos V, Contreras-Yanez I, Rivera-Hoyos P, Enriquez L, Ramirez-Anguiano J. Cumulative disease activity predicts incidental hearing impairment in patients with rheumatoid arthritis (RA). Clin Rheumatol. 2014;33:315–21. Disclosure of Interest None declared

Background 18F-fluoride uptake on positron emission tomography (PET) represents osteoblastic activity. Previous cross-sectional studies showed that increased 18F-fluoride uptake lesions at vertebral corners were associated with both inflammation and structural changes on magnetic resonance imaging (MRI) and radiography, respectively, in patients with ankylosing spondylitis (AS) 1,2 . But, longitudinal studies that investigated the association between increased 18F-fluoride uptake lesions and future syndesmophytes formation are lacking. Objectives We aimed to demonstrate that increased 18F-fluoride uptake lesions on PET predict the development of new syndesmophytes. Methods In 12 patients with AS, 18F-fluoride PET-MRI (Philips Healthcare, Cleveland, OH, USA) was performed at baseline and radiography was performed at baseline and 2 years. We recorded 18F-fluoride uptake lesions on PET, acute (type A) and advanced (type B) corner inflammatory lesions (CILs) and fat lesions on MRI and syndesmophytes on radiography. An increased 18F-fluoride uptake lesion was defined as an uptake greater than the uptake in the adjacent normal vertebral body (Figure 1). Results Of 231 anterior vertebral corners without syndesmophyte at baseline, 13 type A CILs (5.5%), 2 type B CILs (0.9%) and 20 fat lesions (8.7%) on MRI and 6 increased fluoride uptake lesions (2.6%) on PET were observed. After 2 years, 16 new syndesmophytes (6.9%) in 8 AS patients (66.7%) occurred. New syndesmophytes developed significantly more frequently in anterior vertebral corners with increased 18F-fluoride uptake lesions (50%) or fat lesions (25%) at baseline, as compared with those without either feature (5.8% and 5.2%, respectively). In generalised linear latent mixed models after adjusting within-patient correlation, baseline increased 18F-fluoride uptake lesion significantly predicted the development of new syndesmophytes (OR=20.6, 95% CI=2.7–156.1, p=0.003). Fat lesions were also associated with new syndesmophytes development (OR=9.3, 95% CI=2.1–40.2, p=0.003), but this association was not observed in CILs. Conclusions Our findings indicate that increased 18F-fluoride uptake lesions can predict future new syndesmophytes formation in patients with AS. 18F-fluoride PET may be used to estimate structural damage in these patients. References Lee SG et al. Assessment of bone synthetic activity in inflammatory lesions and syndesmophytes in patients with ankylosing spondylitis: the potential role of 18F-fluoride positron emission tomography-magnetic resonance imaging. Clin Exp Rheumatol 2015;33:90–7. Buchbender C et al. Hybrid 18F-labeled Fluoride Positron Emission Tomography/Magnetic Resonance (MR) Imaging of the Sacroiliac Joints and the Spine in Patients with Axial Spondyloarthritis: A Pilot Study Exploring the Link of MR Bone Pathologies and Increased Osteoblastic Activity. J Rheumatol 2015;42:1631–7. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is chronic inflammatory disease characterized by persistent synovitis and structural joint damage with T cell-driven inflammation. Tacrolimus suppress activation of T cells through the inhibition of calcineurin. Objectives We evaluated the efficacy and safety of Tacrobell® (Tacrolimus from Chong Kun Dang Pharma Inc.) in Korean active RA patient who had inadequate response to disease-modifying anti-rheumatic drugs (DMARDs) including Methotrexate (MTX). Methods During the study period from Aug. 2012 to Jun. 2015, in this open labeled, multicenter study, 111 patients were enrolled. Patients were in active disease state with Disease Activity Score28 (DAS28) ≥3.2 despite previously taken at least one conventional DMARD including MTX. Patients had wash out period with DMARDs, except MTX. Patients received Tacrobell® during 24 weeks. The initial dose was 1 mg once daily and was increased to 3mg once daily by 1mg, every 4 weeks. The disease activity was measured by the DAS28-ESR at 4, 8, 16, 24-week after the add on Tacrobell®. Simplified Disease Activity Index (SDAI), Korean Health Assessment Questionnaire (KHAQ)-20, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and the safety was assessed. Results Data from 97 patients were evaluated in full set analysis. At week-24, EULAR response rate were 83.5% (81 of 97) with improvements from week-16 in 74.2% (72 of 97). Mean DAS28-ESR was continuously decreased of 5.64 at baseline, 4.14 (±1.22, p p p p p p =0.0578) at baseline to 1.34 (±3.02, p =0.0367) at week-24. The most common adverse events were in gastrointestinal (18 of 108; 16.679%) and respiratory disorder (12 of 108; 16.67%). In serious adverse events (6 of 108, 5.56%), two cases (pneumonia, high glucose level) were related with Tacrobell® and recovered with treatment. At laboratory exam, no abnormal findings with increased BUN or Cr as known common Tacrolimus side effect. Systolic blood pressure increased 2.12 mmHg at week-8. Conclusions This study demonstrated the efficacy of add on Tacrobell® therapy to MTX in patients with active RA. References Tsutomu T., et al (2013) Post-marketing surveillance of the safety and effectiveness of tacrolimus in 3,267 Japanese patients with rheumatoid arthritis Mod Rheumatol.; 24(1):8–16 Takeyuki K., et al (2013) Long-term therapeutic effects and safety of tacrolimus added to methotrexate in patients with rheumatoid arthritis Rheumatol Int.; 33:871–877 Mariko K., et al (2013) Efficacy of adjunct tacrolimus treatment in patients with rheumatoid arthritis with inadequate responses to methotrexate Mod Rheumatol.; 23:788–793 Kawai S., et al. (2011) Efficacy and safety of additional use of tacrolimus in patients with early rheumatoid arthritis with inadequate response to DMARDs-a multicenter, double-blind, parallel-group trial Mod Rheumatol.; 21(5):458–68 Disclosure of Interest None declared

Background Although a number of studies have reported that hyperuricemia and gout are independent risk factors for the development of cardiovascular disease (CVD), little is known about the relationship between hyperuricemia or gout and arterial stiffness. Objectives This study sought to compare carotid arterial stiffness in gout patients and healthy controls, and evaluate the predictive factors for arterial stiffness in male patients with gout using carotid ultrasonography. Methods In this cross-sectional study, 69 male gout patients and 64 male healthy controls without any known CVD were prospectively analyzed. Carotid artery stiffness index β (β-index) and the intima-media thickness (IMT) were measured as surrogate markers of preclinical atherosclerosis. We also measured serum uric acid, high sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), lipid profiles, and renal function. Adjusted comparison of the β-index and cIMT in both groups and their associations with clinical parameters were investigated. Results The gout group showed higher ESR, Cr, prevalence of HT and DM than the control group (p Conclusions Patients with gout had increased carotid arterial stiffness, which was significantly related to gout duration rather than serum uric acid level or status of inflammation. References Richette P, Perez-Ruiz F, Doherty M, Jansen TL, Nuki G, Pascual E, Punzi L, So AK, Bardin T. (2014) Improving cardiovascular and renal outcomes in gout: what should we target? Nat Rev Rheumatol. 10(11):654–61. Perez-Ruiz F, Becker MA. (2015) Inflammation: a possible mechanism for a causative role of hyperuricemia/gout in cardiovascular disease. Curr Med Res Opin. 31 Suppl 2:9–14. Disclosure of Interest None declared

Background Drug survival can be considered as a composite measure of efficacy and safety in clinical practice. Although the drug survival rate of biologic agents in the treatment of rheumatoid arthritis (RA) has recently been extensively studied, only few studies have examined the drug survival rate for tacrolimus (TAC) in such cases. Objectives The present study aimed to investigate the drug survival rate of TAC in the treatment of RA and to analyse the potential predictors of this rate in routine clinical care. Methods In this retrospective longitudinal study, we enrolled 102 RA patients treated with TAC for at least 1 year from April 2009 to January 2014 at a tertiary centre in South Korea. The causes of TAC discontinuation were classified as lack of efficacy (LOE), adverse events (AEs), and others (patient or medical decision and miscellaneous). The drug survival rate was estimated using the Kaplan-Meier method and the predictors of this rate were identified by Cox-regression analyses. Results TAC was discontinued in 27 of 102 RA patients (26.5%), after a mean duration of 34.1 months; the number of TAC discontinuations due to LOE, AEs, and others was 15 (14.7%), 11 (10.8%) and 1 (1%), respectively. The 2-year survival rate for TAC was 78.3% (Figure 1). Multivariable Cox-regression models indicated that compared to RA patients with low or moderate disease activity (Disease Activity Score 28-erythrocyte sedimentation rate [DAS28-ESR] ≤5.1), RA patients with high baseline disease activity had a significantly higher risk of TAC discontinuation, regardless of the cause (HR=2.49; 95% CI=1.16-5.35, p=0.019), or specifically, due to LOE (HR=3.55; 95% CI=1.25-10.09, p=0.02). Moreover, younger age ( Conclusions In the present study, RA patients exhibited a good 2-year TAC survival rate of 78.3%. Moreover, a high baseline disease activity was a significant predictor for TAC withdrawal, regardless of the cause, or specifically, due to LOE. Disclosure of Interest None declared

Background Erectile dysfunction (ED) is prevalent among men with a variety of chronic medical conditions, including obesity, alcohol use, age, diabetes and cardiovascular disease. ED is caused by many factors such as psychogenic and organic (arteriogenic, cavernosal, neurogenic, anatomic and, endocrinologic) impairment. Gout is the most common inflammatory arthritis associated with subclinical endothelial dysfunction. Objectives We investigated the status of ED in patients with gout who were using uric acid lowering agents and did not developed a flare-up, compared to healthy controls and studied correlation of ED with brachial-ankle pulse wave velocity and medical conditions of patients with gout. Methods In this cross sectional study, total 208 male subjects were enrolled. Patients with well controlled gout (n=120) and health check-up controls (n=87). Erectile function was assessed by the International Index of Erectile Function (IIEF5) questionnaire. We checked brachial-ankle pulse wave velocity (baPWV), ankle brachial pressure index (ABI), heart rate variability (HRV) calculated by spectral analysis (high frequency (HF) and low frequency (LF)) and laboratory tests. Results There was no significant difference in age, weight, smoking, alcohol, blood pressure, serum uric acid and HRV variables between patients group and healthy control group. In IIEF total score, control group was higher than gout patients (17.9±0.7 Vs 14.1±0.5, p Conclusions The prevalence of ED is higher in patients with gout. Moderate to severe ED is associated with age, duration of gout, baPWV. Age and baPWV are independently associated with ED. The result of baPWV that assesses arterial stiffness is significantly correlated with ED for patients with gout Disclosure of Interest None declared

Background A growing body of evidence supports that patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular diseases (CVDs). Early detection of vascular lesions in the preclinical phase would be of great benefit for CVD prevention and its prognosis. Several non-invasive methods have been developed and used for early detection of vascular changes in patients with RA. Objectives The aim of this study was to investigate the carotid arterial stiffness in RA patients without cardiovascular risk factors using echo-tracking ultrasonography and its association with clinical parameters of RA. Methods This study included 51 female RA patients and 44 female healthy controls without any known traditional CV risk factors. Arterial stiffness index β (β index) is assessed by echo-tracking ultrasonography in the common carotid artery (CCA) and the carotid intima-media thickness (cIMT) were also measured. RA activity was assessed by high sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR) and disease activity score in 28 joints (DAS28). 25-hydroxyvitamin D (25(OH)D) and autoantibodies such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (anti-CCP) were checked. Results Compared with the control group, the RA group were significantly higher β index (9.371±2.927 vs 7.397±3.140, p=0.02). However, we did not find any differences in IMT between two groups. In the RA group, β index was significantly correlated with age (r =0.435, p=0.001), disease duration (r=0.373, p=0.007) and RF (r=0.412, p=0.003). Older age and longer disease duration were associated with increased β index in univariable regression analyses (Table 1). Multivariable regression analysis also revealed that the significant predictors of β index were age and disease duration after adjustment for confounding factors (Table 1). Conclusions RA is associated with preclinical vascular changes, characterized by increased carotid β index values, which have been shown to be related to age and disease duration rather than autoantibodies or disease activity. References Villa-Forte A, Mandell BF. Cardiovascular disease and rheumatic disease. Rev Esp Cardiol 2011;64(9):809-817. Mackenzie IS, Wilkinson IB, Cockcroft JR. Assessment of arterial stiffness in clinical practice. QJM 2002;95(2):67-74. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2897

Background Although there is increasing evidence that low serum 25-hydroxy vitamin D (25-OHD) is associated with a higher frequency of cardiovascular diseases (CVDs) in the general population, little attention has been given to the relationship between vitamin D deficiency and atherosclerosis in patients with rheumatoid arthritis (RA). Objectives The present study aimed to investigate whether vitamin D deficiency is a potential risk factor for carotid atherosclerosis in patients with (RA). Methods With a cross-sectional design, we recruited 60 consecutive female RA patients without previous CVDs between September 2013 and December 2013 at the outpatient rheumatology clinic of a tertiary referral centre in South Korea. Carotid intima media thickness (CIMT) was measured using high-resolution ultrasonography (Philips HD15, Bothwell, WA, USA) and QLAB9s IMT-quantification software plug-in (Philips Healthcare, DA Best, The Netherlands) was used to enhance the consistency and reliability of CIMT measurement. Serum 25-OHD levels were assessed by radioimmunoassay. Stepwise multivariable linear regression models were used to evaluate the association between serum 25-OHD levels and CIMT. Results Mean (SD) age and disease duration were 56.0 (11.2) and 5.9 (4.9) years, respectively. Median 25-OHD levels (IQR) was 14.0 (11.0-20.7) ng/mL and 74% of patients had vitamin D deficiency ( Conclusions Our data suggests that vitamin D deficiency is a risk factor for subclinical atherosclerosis in female patients with RA. Larger prospective studies are needed to confirm our observation. Acknowledgements None Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1510

Background Rheumatoid factor (RF) has been suggested as an independent risk factor for ischemic heart disease in the general population by some studies, but the role of RF on arterial stiffness and cardiovascular risk in the subjects without joint symptoms is not defined. Objectives We investigated the arterial stiffness in the subjects without joint symptom using pulse wave velocity (PWV), calculated Framingham risk score (FRS), which is used to estimate the cardiovascular risk, and analyzed whether arterial stiffness and FRS were affected by RF. Methods 242 subjects (164 men, 78 women, 51.2±8.9 years) were included in this population-based study. RF was quantified using turbid immunometry (Advia 1800, Siemens) with cut-off >15 IU/ml for positive values. Information obtained on joint symptoms. Brachial ankle PWV (baPWV) was measured with an automated device. Adjusted comparison of baPWV in RF-positive and RF-negative subjects was performed. Results Of 242 subjects, 15 had positive RF. RF-positive subjects without joint symptoms had higher baPWV than RF-negative subjects (1472.6±251.0/1408.6±226.1 cm/s, p=0.293), and higher FRS (16.2±10.2/11.9±9.7), but both figures did not reach the statistical significance. However, when we divided the subjects into 2 groups (group A – high RF, ≥40, group B – low RF, Conclusions In general population without joint symptoms, higher RF was associated with increased arterial stiffness, suggesting a pathophysiologic link between RF and endothelial dysfunction. References Tomasson G, Aspelund T, Jonsson T, et al. The effect of rheumatoid factor on mortality and coronary heart disease. Ann Rheum Dis 2010;69(9):1649-54 Del Rincon ID, Williams K, Stern MP, et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 2001;44(12):2737-45 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2930

Background Muscle symptoms are frequent in thyroid diseases, and it has been recognized that there are significant similarities between the clinical findings in FM and symptoms of thyroid dysfunction. Some recent reports have found clinical and biochemical features of muscle dysfunction even in subclinical hypothyroidism. Another study reported that FM patients had some problems in the production or utilization of thyroid hormones, and there was an association between thyroid autoimmunity and FM. Objectives we performed this study to evaluate the effect of thyroid hormone variation and in particular, the effect of ‘high-normal’ TSH with positive antithyroid antibodies on endothelial function in euthyroid FM patients, using pulse wave velocity(PWV), which assess endothelial function by measuring the status of large and small arteries in the lower extremity. Methods This study included 155 postmenopausal female FM patients (51.5±8.9 years) without any known cardiovascular diseases within a normal reference range of thyroid-stimulating hormone (TSH) levels (0.4–4.5mIU/ml). The clinical parameters including Fibromyalgia Impact questionnaire (FIQ), pain visual analogical scale (VAS) and tender point counts and immunologic tests including rheumatoid factor and antinuclear antibody were measured. Vascular function was assessed by brachial-ankle pulse wave velocity (baPWV), augmentation index and flow-mediated dilation (FMD). We evaluated the associations between arterial markers and serum TSH, free thyroxin, as well as serum thyroidperoxidase autoantibody. Results The baPWV values of positive TPO Ab and those with negative TPO Ab (1632.1±385.2 cm/sec vs. 1323.2±210.7 cm/sec, P =0.015) were significantly different. Mean levels of PWV and FMD did not increase linearly across increasing TSH quartiles. No associations were found between the remaining markers and levels of thyroid hormones, whereas thyroid antibodies were significantly associated with baPWV (r=0.337, p=0.007). Linear regression analysis revealed that the only significant predictors of baPWV were age, FIQ and presence of TPO Ab. No significant association was found between FMD and positive anti-TPO antibodies. Conclusions FM women with positive TPO antibodies have increased arterial stiffness compared to women with negative TPO antibodies. The combined thyroid autoimmunity in FM patients may need re-evaluation with respect to the effects on the vasculature. Disclosure of Interest None Declared

Background Metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is common manifestation of RA. However, whether MetS is more prevalent in patients with rheumatoid arthritis (RA) as compared to the general population is somewhat compelling, especially in Asians. Objectives To compare the frequency of MetS and the magnitude of insulin resistance measured by homeostasis model assessment for insulin resistance (HOMA-IR) between South Korean women with RA and healthy subjects and to evaluate risk factors for the presence of MetS and increased HOMA-IR in RA patients. Methods In a cross-sectional setting, 84 female patients with RA and 109 age-matched female healthy subjects were consecutively recruited at the university affiliated rheumatology center in South Korea from January 2008 to December 2009. Mets was defined according to the Third report of the National Cholesterol Education Program’s Adult Treatment Panel (NCEP-ATP III) 2004 using the Asian criteria for central obesity when 3 or more of the following components were presents: 1) increased waist circumference to ≥80 cm in women, 2) elevated blood pressure to ≥130/85 mmHg or requiring drug therapy, 3) elevated serum TG level to ≥150 mg/dl, 4) reduced serum HDL-C to ≤50 mg/dl in women, and 5) elevated fasting glucose level to ≥100 mg/dl or requiring drug therapy. Results No significant difference in the frequency of MetS between RA patients (19%) and healthy subjects (15.6%) was demonstrated (p=0.566), whereas RA patients has a higher HOMA-IR than healthy subjects (median 1.27 versus 0.73, p Conclusions Apart from increased insulin resistance, the frequency of MetS in South Korean women with RA was not significantly higher than in healthy subjects. Despite no obvious risk factors for the presence of MetS were found, inflammation (CRP) and disease activity (DAS28-ESR) significantly contributed to increased insulin resistance in RA patients in the present study. References Sidiropoulos PI, Karvounaris SA, Boumpas DT. Metabolic syndrome in rheumatic diseases: epidemiology, pathophysiology, and clinical implications. Arthritis Res Ther. 2008;10(3):207. Disclosure of Interest None Declared

Background Althogh pulmonary arterial hypertension (PAH) is a severe manifestation of systemic lupus erythematosus (SLE), the pathogenesis of PAH associated with SLE is yet unclear. Objectives In this study, we evaluated the carotid atherosclerosis, elastic properties of the common carotid artery (CCA), reflected by the values of strain of the carotid artery wall based on the speckle tracking imaging, and investigated the association between the parameters of carotid arterial stiffness and clinical, laboratory parameters of systemic inflammatory activity in SLE patients accompanied with PAH. Methods Measurement of carotid artery strain parameters and Doppler echocardiography was performed in 50 patients with SLE. Fifty healthy volunteers (52.1 ± 12.0 years, women) from the health screening center were selected as control group. Exclusion criteria for both groups were smoking (in the last 5 years), diabetes mellitus (DM), hypertension, hypercholesterolemia, pregnancy, renal failure, chronic hepatopathy, nephrotic syndrome, and hypothyroidism. We also excluded patients with symptoms or signs of right heart failure and patients with pulmonary hypertension associated with left-sided heart disease, pulmonary thromboembolism, hypoxemia, or known other causes of secondary pulmonary hypertension. PAH was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 40 mmHg. All patients were subjected to full history taking, laboratory studies and chest x-ray. SLE activity was assessed by SLE disease activity index (SLEDAI). Results In 50 SLE patients, PAH was detected in 6 patients (16 %). Patients with PHT showed reduced RV function represented by higher RV myocardial performance index and reduced RV strain. Significantly higher frequency of anti-cardiolipin antibodies were found in patients with PAH versus those without (P = 0.008). BaPWV and positive ACL were significantly associated with occurrence of PAH in SLE (P = 0.007, P = 0.006 respectively). No significant correlations were found between pulmonary artery pressure, disease duration, SLE Disease Activity Index (SLEDAI), ESR, and anti-ds DNA titers. Conclusions Patients with SLE have an increased risk of PAH. Positive anti-cardiolipin antibodies and was significant predictors of pulmonary hypertension in our study. The significant association of LAC and presence of APS in PAH cases suggests that thrombosis may play an important role in PAH with SLE. References Disclosure of Interest None Declared

Background Fibromyalgia (FMS) is frequently associated with depression. Depression is a risk factor for cardiac morbidity and mortality in patients with coronary heart disease (CHD). Low heart rate variability (HRV) reflects excessive sympathetic or inadequate parasympathetic tone. Increased sympathetic or decreased parasympathetic nervous system activity predisposes patients with CHD. Little is known about whether depressive symptom in FMS is associated with reduced HRV, which is increased risk factor for CHD. Objectives To investigate the relationship between depression and HRV in patients with fibromyalgia. Methods We performed power spectral analysis on 5 minutes ECG in 130 patients with FMS between 24 and 73 years. All subjects have been evaluated with Korean version of the Fibromyalgia Impact Questionnaire (FIQ) and Beck Depression Inventory (BDI). BDI scores were classified as 3 groups: low (1-16, n=30), moderate (17-30, n=44) and severe (over 31, n=56). Very low frequency (VLF) power (0.0033 to 0.04 Hz) in ms 2 , which may be influenced by sympathetic and parasympathetic inputs; low frequency (LF) power (0.04 to 0.15 Hz) in ms 2 , which reflects both sympathetic and parasympathetic tone and is strongly associated with blood pressure regulation; and high frequency (HF) power (0.15 to 0.40 Hz) in ms 2 , which is modulated by respiration and primarily reflects vagal tone. Results The results of the one way ANOVA indicated that there was a difference in log-transformed High Frequency (HF) level amongst the BDI groups [F(2, 127)=3.89, p=.002]. Post-hoc comparisons using the Tukey B test indicated that severe BDI score group (3.9±1.2) has significantly lower HF level than the other BDI score groups. Low BDI score group (4.7±1.3) did not differ significantly from moderate BDI score group (4.5±1.3). There was no significant difference in VLF and LF in patients with FMS. BDI score showed negatively significant correlation with lnHF (r=-0.23, p Conclusions BDI scores in patients with FMS was negatively correlated with lnHF and the group with severe BDI scores showed significantly lower HF than the other BDI groups. Reduced vagal tone is associated with depressive symtoms in patients with FMS. References Carney R, Saunders R, Freedland K, Stein P, Rich M, Jaffe A. Association of depression with reduced heart rate variability in coronary artery disease. Am J Cardiol 1995;76:562-4. Staud R. Heart rate variability as a biomarker of fibromyalgia syndrome. Fut Rheumatol. 2008 Oct 1;3(5):475-483. Disclosure of Interest None Declared

Background Although a series of trials support systemic lupus erythematosus (SLE) is associated with increased atherosclerosis and cardiovascular events, the link between microvascular structural change and the disease activity of SLE is not defined. Objectives We measured retinal microvasculature change by fundus photography and fluorescent angiography (FAG) and investigated the association between retinal vasculature and clinical parameters of SLE. Methods Fifty SLE patients and fifty healthy controls were included. Morphometric and quantitative features of the capillary image including retinal vascular sign and vessel diameters were measured with fundus photography and FAG. Information concerning SLE duration, cumulative dose of steroids and/or immunosuppressive drug intake were recorded, and autoantibodies were checked. SLE activity was assessed by SLE disease activity index (SLEDAI). Results The mean Central retinal arteriolar equivalent (CRAE) was 89.7 ± 14.5 µm in SLE patients, 123.8 ± 19.9 µm in control, showing narrower arteriole in SLE patients, and were significantly narrower than that of control (p Conclusions retinopathy and retinal arteriolar narrowing were more common in SLE patients, and retinal arteriolar diameter had significant correlation with hsCRP and IgG aCL levels. Retinal imaging is a comparative method for the assessment of microvascular findings of SLE patients. Disclosure of Interest None Declared

Background Nailfold capillaroscopy (NC) represents the method to analyze microvascular abnormalities in autoimmune rheumatic diseases, but the pathophysiological link between the microvascular derangement which is seen in NC and endothelial function is yet to be discovered. Objectives We investigated the association between endothelial function which is assessed by brachial artery flow-mediated dilatation (FMD) and NC patterns in patients with Raynaud’s phenomenon (RP). Methods 37 postmenopausal women with secondary RP and 23 controls suffering from hand numbness were evaluated with NC using a digital microscope at 400× and 100 × magnifications. The microvascular alterations were classified into three different patterns, early, active and late. Endothelial function was examined by brachial FMD (endothelium dependent) and response to 40 µg of sublingual nitroglycerine (NTG-induced dilatation, endothelium independent). Results There were significant capillary loop dilatation (apical width; 14.1±5.6 vs. 10.4±1.7 μm, p=0.001 and total width; 40.6±15.1 vs. 31.6±4.6 μm, p=0.002) and length (316.0±78.5 vs. 270.4±34.7 μm, p=0.004) in secondary RP compared to controls. Giant capillaries, loss of capillaries, hemorrhage and background pallor were much more prevalent in secondary RP as compared to controls (all P’s P =0.091), significant decreases in the FMD value (6.1±3.5% vs. 9.0±2.2%, P ) were noted. Both FMD and NTG-induced dilatation showed a significant inverse association with severity of NC findings (r=-0.355, p=0.005 and r=-0.285, p=028). Conclusions Significantly impaired endothelial function was found in secondary RP and capillary enlargement was significantly associated with endothelial dysfunction. This result might implicate that the recognition of abnormal capillaroscopic patterns in the secondary RP might be prognostic for the early detection of microvascular heart involvement. Disclosure of Interest : None Declared