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ObjectiveGenome-wide association studies (GWAS) have identified >100 risk loci for systemic lupus erythematosus (SLE), but the disease genes at most loci remain unclear, hampering translation of these genetic discoveries. We aimed to prioritise genes underlying the 110 SLE loci that were identified in the latest East Asian GWAS meta-analysis.MethodsWe built gene expression predictive models in blood B cells, CD4+and CD8+T cells, monocytes, natural killer cells and peripheral blood cells of 105 Japanese individuals. We performed a transcriptome-wide association study (TWAS) using data from the latest genome-wide association meta-analysis of 208 370 East Asians and searched for candidate genes using TWAS and three data-driven computational approaches.ResultsTWAS identified 171 genes for SLE (p–5); 114 (66.7%) showed significance only in a single cell type; 127 (74.3%) were in SLE GWAS loci. TWAS identified a strong association betweenCD83and SLE (p–8). Meta-analysis of genetic associations in the existing 208 370 East Asian and additional 1498 cases and 3330 controls found a novel single-variant association at rs72836542 (OR=1.11, p=4.5×10–9) aroundCD83. For the 110 SLE loci, we identified 276 gene candidates, including 104 genes at recently-identified SLE novel loci. We demonstrated in vitro that putative causal variant rs61759532 exhibited an allele-specific regulatory effect onACAP1, and that presence of the SLE risk allele decreasedACAP1expression.ConclusionsCell-level TWAS in six types of immune cells complemented SLE gene discovery and guided the identification of novel genetic associations. The gene findings shed biological insights into SLE genetic associations.

Predicting radiographic progression is vital for assessing the prognosis of patients with radiographic axial spondyloarthritis, and C-reactive protein (CRP) may be a valuable biomarker for this purpose. This study aimed to investigate the relationship between changes in the CRP level and spinal radiographic progression in patients with radiographic axial spondyloarthritis who were initially treated with non-biologics.Patients with radiographic axial spondyloarthritis who were followed up for 18 years at a single center and initially treated with nonsteroidal anti-inflammatory drugs and/or conventional disease-modifying antirheumatic drugs for 3 months were included. Patients with a CRP level of0.8 mg/dL or 50% of the baseline CRP at 3 months were assigned to the controlled CRP group (n = 351), and the remaining patients were assigned to the uncontrolled CRP group (n = 452). A generalized estimating equation was used to analyze the differences in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) between the 2 groups.The increase in the mSASSS was slower in the controlled CRP group than in the uncontrolled CRP group (interaction term β = -.499, 95% confidence interval -0.699 to -0.300).Controlled CRP achieved in response to initial treatment with non-biologic agents for 3 months was significantly associated with a slower rate of spinal radiographic change in patients with radiographic axial spondyloarthritis. The CRP level at 3 months after initial non-biologic treatment is a good predictor of radiographic progression.

Objective. To elucidate whether clinical features and the weighted genetic risk score (wGRS) were associated with the presence of lupus nephritis (LN). Methods. We retrospectively divided patients with systemic lupus erythematosus (SLE, n=1,078) into biopsy-proven LN (n=507) and non-LN groups (non-LN, n=571). Baseline clinical features, serologic markers, and the wGRS were collected. The wGRS was calculated from 112 non-human leukocyte antigen (non-HLA) loci and HLA-DRβ1 amino acid haplotypes for SLE. Associations among clinical features, wGRS, and the presence of LN were identified. Results. In the multivariate analysis, patients with LN were younger at diagnosis (odds ratio [OR]=0.97, p＜0.001), had more pleuritis (OR=2.44, p＜0.001) and pericarditis (OR=1.62, p=0.029), had a higher detection rate of anti-double stranded deoxyribonucleic acid (anti-dsDNA antibodies, OR=2.22, p＜0.001), anti-Smith antibodies (anti-Sm antibodies, OR=1.70, p=0.002), low level of complement (OR=1.37, p=0.043) and absence of antiphospholipid antibodies (aPL antibodies, OR=1.60, p=0.002), and had higher wGRS (OR=1.16, p=0.012). Mediation analysis suggested that anti-Sm antibodies and low complement could be mediators in the relationship between high wGRS and the presence of LN. Conclusion. Onset age, pleuritis, pericarditis, several serologic markers, and wGRS were associated with the presence of LN. Anti-Sm antibodies and low complement appeared to mediate the indirect relationship between wGRS and the presence of LN. (J Rheum Dis 2021;28:150-158)

Objectives To investigate the causes and risk of death in a large cohort of Korean patients with rheumatoid arthritis (RA). Methods Patients in the Hanyang BAE (Bae registry of Autoimmune diseases for Epidemiology) RA cohort who fulfilled the American College of Rheumatology criteria were analyzed. A total of 2355 patients were enrolled from October 2001 to December 2015. Mortality data were derived by linking with data from the Korean National Statistical Office. Standardized mortality ratio was estimated by dividing observed deaths by expected number of deaths in the general population. Results Over the observation period, 225 deaths were reported. Total age- and sex-adjusted standardized mortality ratio was 1.65 (95% confidence interval 1.44-1.87). The most common cause of death was malignancy (40 cases; 17.8%), followed by respiratory disease (38 cases; 16.9%) and cardiovascular disease (32 cases; 14.2%). Mortality rate and causes of death differed according to year and age of RA onset. Compared with survivors, individuals who died were more likely to be male, smokers, diagnosed with RA at an older age, and to have long disease duration, higher erythrocyte sedimentation rate and C-reactive protein, higher rheumatoid factor positivity rate, more severe radiographic damage, and more comorbidities. Conclusion The mortality rate of patients with RA remains higher than that of the general population. Therefore, to improve the survival of patients with RA, attention should be paid to the management of comorbidities as well as to the RA itself.

Background Rituximab (RTX), a monoclonal antibody that selectively binds to CD20+ B cells, showed favorable outcomes in patients with idiopathic inflammatory myopathies (IIM) in small case series, but the evidence is still not enough. Our goal was to determine the efficacy and safety of RTX for Korean patients with refractory IIM. Methods We retrospectively analyzed the medical records of 16 patients with refractory IIM treated with RTX in seven tertiary rheumatology clinics in the Korea. The efficacy of RTX was evaluated with the improvement of serum creatine phosphokinase (CPK) level and physician's global assessment (PGA), and daily corticosteroid dose reduction. A > 25% decrease in CPK level, corticosteroid dose, or PGA was considered significant. A complete response (CR) was designated by meeting three efficacy criteria and a partial response (PR) by only two criteria. Results Sixteen patients with IIM were evaluated (13 female; median age, 51.8 years). All patients had received at least one conventional immunosuppressive agent (median, 3.6 [2.0–5.0]) and concomitant corticosteroids. The median CPK level and median dose of prednisolone was 421.0 units/L and 20.0 mg/day respectively. Eleven patients were treated with intravenous immunoglobulin. Seven patients received 2,000 mg of RTX and the others received lower dose. Twenty-four weeks after RTX treatment, 11 patients achieved a > 25% reduction in corticosteroid dose and CPK levels, and nine showed improved PGA. The overall response rate was 68.8% (11 patients). At the end of follow-up (median 24 weeks), 12 (75.0%) patients responded overall: four (25.0%) and eight (50.0%) patients achieved CR and PR, respectively. Baseline muscle enzyme levels were higher in responders than non-responders, but disease duration, RTX dose, ESR and serum CRP were not significantly different between the two groups. The rate of adverse event was 25.4/1,000 person-years. Conclusion RTX could be an effective and relatively safe therapeutic option in patients with refractory IIM., Graphical Abstract

White matter hyperintensities (WMH) and cerebral microbleeds (CMBs) are known to be associated with small vessel diseases (SVD) and neuroinflammation. The purpose was to investigate the relationship between CMBs and WMH in patients with systemic lupus erythematosus (SLE). Thirty-one SLE patients with WMH and 27 SLE patients with normal brain MRI were compared. The presence, location, and grading of CMBs were assessed using susceptibility-weighted images. WMH volume was quantitatively measured. Clinical characteristics and serologic markers were compared. We also performed two separate subgroup analyses after (1) dividing WMH into inflammatory lesion vs. SVD subgroups and (2) dividing WMH into those with vs. without CMB subgroups. The WMH group showed more frequent CMBs than the normal MR group (p

AIM This study aimed to translate the Functional Index for Hand Osteoarthritis (FIHOA) into Korean, and establish its reliability and validity in Korean patients with hand osteoarthritis (OA). METHOD The FIHOA was translated into Korean (K-FIHOA) following cross-cultural adaptation guidelines. The K-FIHOA was pretested on 40 patients with hand OA. The adapted K-FIHOA was then administered to 100 consecutive hand OA patients together with the modified Health Assessment Questionnaire (mHAQ) and visual analog scale (VAS) for hand pain. The test-retest reliability of each item and total scores were assessed using Spearman's correlation coefficient and intraclass correlation coefficient (ICC). The internal consistency reliability was evaluated as Cronbach's alpha. The external construct validity was assessed using the correlation between K-FIHOA, mHAQ and hand pain VAS. RESULTS The test-retest reliability for the total score was strong (r = 0.87 and ICC = 0.83). Cronbach's alpha was also high (0.88), which suggests that there is strong internal coherence in the test items. We identified significant correlations between K-FIHOA and mHAQ (r = 0.52, P

OBJECTIVES To investigate the impact of European Scleroderma Trials and Research (EUSTAR) standardized training on the accuracy of modified Rodnan skin score (mRSS) in patients with systemic sclerosis (SSc). METHODS Eight SSc patients (four diffuse, four limited) and 10 physicians (4 fellows, 6 professors) were included. Gold-standard mRSS was performed by a senior instructor. Training comprised a video presentation and a live demonstration. Each physician performed mRSS with no clinical information in all patients: (a) before training; (b) after video session; and (c) after live demonstration. Primary outcome was the change in scoring accuracy, which was defined as the difference from the gold-standard skin score, as analyzed using a linear mixed model. RESULTS Mean (standard deviation) difference from the gold-standard score in all measurements by participants before the training was 7.7 (9.5). Completion of training significantly enhanced mRSS accuracy (adjusted β = -7.61; 95% CI: -11.91 to -3.32). This was largely attributable to the video presentation (adjusted β = -5.47; -9.16 to -1.78), although the live demonstration was associated with numerical reduction in the difference from the gold-standard score (adjusted β = -2.15; -5.84 to 1.55). Effect of training was prominent in fellows whereas professors showed an increase in the difference from gold-standard score after training (P value for interaction

ObjectivesTumour necrosis factor inhibitors (TNFis) have been suggested to slow radiographic progression in patients with ankylosing spondylitis. However, limitations such as variations in disease activity, complex drug administration and short follow-up duration make it difficult to determine the effect of TNFis on radiographic progression. The aim of the study was to investigate whether long-term treatment with TNFis can reduce radiographic progression in patients with ankylosing spondylitis using 18-year longitudinal real-world data.MethodsThis retrospective study was conducted between January 2001 and December 2018 at a single centre. Among the 1280 patients whose electronic medical records were reviewed, data of 595 patients exposed to TNFis at least once were included. Among them, time intervals of TNFi exposure or non-exposure were determined in 338 patients (‘on the TNFis’ or ‘off the TNFis’ intervals, respectively). The difference in the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) change rate between ‘on the TNFis’ and ‘off the TNFis’ intervals was investigated.ResultsWe obtained 2364 intervals of 338 patients (1281 ‘on the TNFis’ and 1083 ‘off the TNFis’ intervals). In the marginal structural model for inverse probability of treatment weighting, the change rate of mSASSS significantly decreased with the use of TNFis (β=−0.112, p=0.004), and the adjusted mSASSS changes were 0.848 and 0.960 per year during ‘on the TNFis’ and ‘off the TNFis’ intervals, respectively.ConclusionCompared with treatment without TNFis, treatment with TNFis slowed radiologic progression significantly.

AIM Systemic lupus erythematosus (SLE) causes irreversible damage to organ systems. Recently, evidence has been obtained for subphenotypes of SLE. This study aimed to identify damage clusters and compare the associated clinical manifestations, SLE disease activity, mortality, and genetic risk scores (GRS). METHODS The study was conducted on the Hanyang BAE lupus cohort. Patients with disease duration

Background Damage in SLE is an irreversible change of organ system results from SLE involvement or adverse effects of medications. Recently, the awareness and evidence of subphenotypes in SLE has been increased. In this study, thus we are to identify damage clusters and compare organ damage involvement, demographic and clinical manifestations, mortality and weighted genetic risk score (GRS) between clusters. Methods The study was conducted from Hanyang Bae lupus Cohort. Patients whose disease duration is less than 5 years were excluded to minimize potential confounding effects of disease duration. Patients were grouped into 3 clusters based on SLICC Damage Index (SDI) at last follow-up visit using K-mean cluster analysis. Comparison of characteristics between clusters were performed using ANOVA and Chi-square test. Results A total number of 1130 patients were analyzed. Both the last follow-up visit, musculoskeletal damage was the most frequent damage domain followed by ocular, renal and neuropsychiatric damage. Three separate damage clusters were identified. Cluster 1 included 824 (72.9%) of patients. None of patients in cluster 1 was accompanied by ocular, neuropsychiatric, renal damage and premature gonadal failure. Patients in cluster 1 had significantly less pulmonary damage than cluster 3, significantly less diabetes mellitus than cluster 2, and significantly less musculoskeletal damage than two the other clusters. Cluster 2 (n=195, 17.3%) was represented by prevalent ocular (58.0%) and renal (55.4%) damage. Patients in cluster 2 had significantly more ocular, renal damage than two the other clusters. All the patients of cluster 3 (n=111, 9.8%) was accompanied by neuropsychiatric damage (100%). Patients in cluster 3 had significantly more musculoskeletal (35.1%) damage than two the other clusters. Age of SLE diagnosis and autoantibody positivity were similar among 3 clusters. Adjusted mean SLEDAI (AMS) was highest in cluster 2 (Mean ±SD, 6.7±4.8), and mortality was highest in cluster 3. Weighted GRS showed no significant difference between clusters. Conclusions We classified patients by patterns of damage involvement (damage cluster) within a SLE cohort. Renal and neuropsychiatric damage were the two distinct domain of damage that classified patients into 3 clinically meaningful clusters. Patients in cluster 2 (prevalent renal and glucocorticoid associated damage) had the highest AMS. The highest mortality was recognized in cluster with prevalent neuropsychiatric damage. Therefore, we should be attentive to prevent renal and neuropsychiatric damage to improve the survival. Funding Source(s): Comparison of demographic and clinical characteristics between damage clusters

Consumer failure experiences lead to negative emotions. These emotions result in a process called ‘Rumination’, which refers to constant contemplation of the related event, cause, and outcome of the negative emotion. Our study focuses on the experiences of consumers' service failure in the mobile environment and the process of cognitive appraisal. A total of 32 individual interviews conducted for women aged of 20s and 30s. This study shows that the consumers’ failed mobile shopping experiences are related to specific negative emotions. Rumination was experienced in general, though the intensity of rumination differed by the type of failures. Mobile shopping, which requires more time to solve service problems such as delivery, exchange, or refund than offline, which is face too face service, has been shown to extend consumers' rumination. Consequently, ruminating the unpleasant experiences led to negative recognition of the underlying factors,resulting in final decisions such as terminating the relationship with particular retailers.

Objective We quantitatively measured the fat fraction (FF) in the vertebrae of patients with ankylosing spondylitis (AS) using magnetic resonance imaging (MRI) and investigated the role of FF as an indicator of both active inflammation and chronicity. Materials and Methods A total of 52 patients with AS who underwent spinal MRI were retrospectively evaluated. The FF values of the anterosuperior and anteroinferior corners of the bone marrow in the L1-S1 spine were assessed using the modified Dixon technique. AS activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), AS Disease Activity Score (ASDAS), and serum inflammatory marker levels. AS disease chronicity was assessed by AS disease duration and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Univariable and multivariable regression analyses were conducted to investigate the correlation between FF and other clinical characteristics. Results The mean FF ± standard deviation of the total lumbar spine was 43.0% ± 11.3%. At univariable analysis, spinal FF showed significant negative correlation with BASDAI (β = −0.474, p = 0.002) and ASDAS with C-reactive protein (ASDAS-CRP; β = −0.478, p = 0.002) and a significant positive correlation with AS disease duration (β = 0.440, p = 0.001). After adjusting for patient age, sex, and total mSASSS score, spinal FF remained significantly negatively correlated with BASDAI (β = −0.543, p < 0.001), ASDAS-CRP (β = −0.568, p < 0.001), and ASDAS with erythrocyte sedimentation rate (β = −0.533, p = 0.001). Spinal FF was significantly lower in patients with very high disease activity (ASDAS-CRP > 3.5) than in those with only high disease activity (2.1 ≤ ASDAS-CRP ≤ 3.5) (p = 0.010). Conclusion Spinal FF may help assess both AS disease activity and chronicity.

We thank Zhang et al 1 for their interest in our study, titled “Tumour necrosis factor inhibitors slow radiographic progression in patients with ankylosing spondylitis: 18-year real-world evidence.” We investigated long-term observational data using advanced statistical methods to determine whether changes in radiographic progression are affected by tumour necrosis factor inhibitors (TNFi) in patients with ankylosing spondylitis (AS).2 However, our study did not consider the risk of osteoporosis or vertebral fractures while evaluating the effects of TNFi. There are several studies on bone mineral density (BMD) in patients with AS. Compared with the general population, patients with AS have a lower BMD.3–5 …

Background:Obesity can be a factor that affects response to tumor necrosis factor inhibitors (TNFi). Few studies have investigated the impact of obesity on the response to TNFi in patients with ankylosing spondylitis (AS).Objectives:The aim of our study was to investigate the impact of different body mass index (BMI) categories on TNFi response in patients with AS.Methods:Patients with AS from the Korean College of Rheumatology Biologics (KOBIO) registry were included in the current study. Patients who started a first TNFi after recruitment, and had available BMI data as well as a baseline and follow-up visit at 1 year (±6 months) were included. Patients with a BMI 30). We evaluated the proportion of patients achieving the 40% improvement in ASAS criteria (ASAS40), as well as Ankylosing Spondylitis Disease Activity Score (ASDAS) improvement status at 1 year.Results:A total of 1003 AS patients starting a first TNFi were considered in the current study (696 patients of normal weight, 267 patients with overweight, and 40 obese patients). After at 1 year follow-up visit, obese individuals were significantly higher ASDAS-CRP levels but were not significantly lower ASDAS major improvement in comparison to patients of normal weight.Conclusion:Obesity is associated with significantly higher ASDAS-CRP at follow-up visit in patients with AS.Disclosure of Interests:None declared

Background:Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune inflammatory disease with increased risk for mortality and cancers possibly because of the effects of systemic inflammation and immunodeficiency due to disease itself and/or cytotoxic agents for SLE management. Although there has been improvement in the prognosis of SLE over decades with the treatment advance including standardized treatment strategy for lupus nephritis and less cytotoxic agents, the improvement also is fixed nowadays.Objectives:In this study, we we are to investigate the mortality and cancer of SLE patients in a longitudinal SLE cohort and compare the morality ratio and incidence of cancer with general population over time.Methods:This study was conducted in Hanyang BAE lupus cohort during the period of 1998 to 2015. Mortality data and malignancy data were derived in connection with data from the Korean National Statistics Office and the Korea Central Incidence Database, respectively. The Standardized Mortality Ratio (SMR) and Standardized Incidence Ratio (SIR) was estimated yearly by dividing the observed number deaths/cancers by the expected number of deaths/cancers of age- and sex- matched general population from matched year.Results:Mortality data were available in 1284 patients and total 71 deaths were observed. The most common cause of death was SLE itself (52.1%) followed by infection (18.3%), cerebrovascular disease (8.5%) and suicide (7.0%). The total age and sex adjusted SMR was 3.4 [95% CI (Confidential Interval) 2.6-4.1]. When we conduct subgroup analysis by age, the sex-adjusted SMR was significantly increased in young and middle aged adult patients: the SMR in patients younger than 20 was 12.2, but it was not significant due to the small number of young patients (observed death 3, expected death 0.3, 95% CI 0-26.0). The adjusted SMR in patients aged 20-39, aged 40-59 and aged over 60 were 9.8 (observed death 35, expected death 4.8, 95% CI 6.5-13.0), 3.7 (observed death 24, expected death 11.5, 95% CI 2.2-5.2), and 1.0 (observed death 9, expected death 10.3, 95% CI 0.3-1.6), respectively. Compared with alive patients, died patients had more serositis and more neurologic disorder according to American College of Rheumatology classification criteria for SLE despite the shorter observational period (5.6 years vs. 9.4 years).Malignancy data were available in 1,020 patients and 56 primary cancers were diagnosed. Solid tumor was developed in 51 patient and hematologic malignancy was developed in 5 patients (3 non-Hodgkin’s lymphoma, 1 solitary plasmacytoma and 1 acute lymphoblastic leukemia). Thyroid cancer was the most common solid cancer (24 patients) followed by colorectal (5 patients), breast (4 patients), cervical cancer (4 patients) and hepatocellular carcinoma (3 patients). The total age and sex adjusted SIR was 1.1 (95% CI 0.8-1.4).Conclusion:Patients with SLE had higher risk of mortality than general population and the younger patients had the higher risk of mortality. The leading cause of death was SLE itself followed by infection and cerebrovascular disease. The risk for cancer in patient with SLE was similar with that of general population.Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) is a common chronic inflammatory disease characterized by arthritis of multiple joints. Although the use of corticosteroid and extra-articular complications may lead increased mortality of patients with RA and it have been confirmed by hundreds of studies, the prognosis of RA has improved over the past decades with the introduction of biologics disease-modifying anti-rheumatic drugs and treat-to-target strategy. Along with the increase of overall survival of RA, the needs for re-assessment of actual life expectancy in patients with RA have also been increased.Objectives:To investigate the cause and the risk of death of Korean patients with RA in a large RA cohort.Methods:We analyzed patients in Hanyang BAE RA cohort who fulfilled the American College of Rheumatology criteria. A total of 2,355 patients were enrolled from October 2001 to December 2015. Mortality data were derived by linking with data from the Korean National Statistical Office and date and cause death were identified. Standardized Mortality Ratio (SMR) was estimated by dividing the observed deaths by the expected number of deaths of age- and sex- matched general population. Confidence intervals were calculated based on the Poisson distribution.Table 1.Comparison of demographic and clinical characteristics of analyzed patientsTotalDied patientsSurvivorsP value(n=2,355)(n=225)(n=2,130)Age at onset41.8 ± 12.849.7 ± 12.741.0 ± 12.5Age at enrollment50.8 ± 12.363.3 ± 9.449.5 ± 11.8Male265 (11.3)42 (18.7)223 (10.5)Disease duration18.1 ± 10.420.7 ± 10.917.8 ± 10.3Observation period9.0 ± 4.47.0 ± 3.69.2 ± 4.5Smoking Never smoker1,953 (83.9)161 (74.9)1,792 (84.8) Former smoker212 (9.1)36 (16.7)176 (8.3) Current smoker164 (7.0)18 (8.4)146 (6.9)Comorbidity Hypertension330 (14.0)63 (28.0)267 (12.5) Diabetes mellitus106 (4.5)24 (10.7)82 (3.9)*Values are number (%) or mean ± standard deviation. ** Missing data were excluded from analysis.Results:Over the observation period, 225 deaths were reported. The age at enrollment was 50.8 ± 12.3 years and disease duration was 18.1 ± 10.4 years. The most common cause of death was malignancy (40 cases) followed by respiratory disease (38 cases), cardiovascular disease (32 cases) and musculoskeletal disease (21 cases). Total SMR was increased [1.7, 95% CI 1.5-2.0] but age- and sex- adjusted SMR was not increased [SMR 1.0, (95% CI 0.9-1.1)]. When we classify patients by age conduct subgroup analysis, sex-adjusted SMR was also similar with that of general population by all group: the adjusted SMR in patients aged 15-39, aged 40-59 and aged over 60 were 0.7 (observed death 1, expected death 1.5, 95% CI 0-2.0), 0.9 (observed death 29, expected death 32 95% CI 0.6-1.3), and 0.9 (observed death 195, expected death 221.0, 95% CI 0.8-1.0), respectively. Compared with survivors, patients who died were more likely to be male (18.7% vs. 10.5%, pConclusion:The overall age- and sex- matched SMR of patients with RA was similar with that of general population. However, compared with survivors, patients who died were more likely to be male, diagnosed with RA at older age, more likely to be smoker, and they have more hypertension and diabetes mellitus. Therefore, attention should be paid not only to RA itself but also managing comorbidities to improve the survival of patients with RA.Disclosure of Interests:None declared

Background:With the promising efficacy and the prevalent use of anti-tumor necrosis factor-α (TNF) agents in managing AS, the risk for reactivation of latent tuberculosis infection (LTBI) still is a concern. Although guidelines include the screening and treatment of LTBI prior to the initiation of anti-TNF agent by QuantiFERON-TB Gold (QFT-G) or tuberculin test, there is a lack of evidence whether treatment of LTBI before initiation of anti-TNF agent may reduce the risk of reactivation to the same as LTBI patient without anti-TNF agent or anti-TNF agent users without LTBI. Furthermore, evidence on the need for follow-up testing and the association between seroconversion and the development of active tuberculosis is also limited.Objectives:This study aims to investigate the real-world impact of QFT-G test on the development of active tuberculosis in patients with AS.Methods:This retrospective study investigated 2,930 patients who had a diagnosis of AS and conducted QFT-G testing during the period of March 1998 to June 2019. 191 patients with history of treatment for LTBI or acute tuberculosis prior to the first QFT-G test and 157 patients whose hospital visits or prescription was less than 3 were excluded. Observational period was defined from the firs QFT-G test to the last hospital visit of development of active tuberculosis. The screening for development of active tuberculosis was conducted by reviewing the diagnosis, prescription of anti-tuberculosis medication, chest images and electronic medical record. Treatment of LTBI was defined when a patient was prescribed isoniazid for at least 220 for 12 months, rifampin for at least 90 days for 6 months, or concurrently prescribed isoniazid and rifampin for at least 70 days for 4 months. Wilcoxon rank-sum test, chi-square test and cox-proportional hazard analysis were performed.Results:A total of 2687 patients (median age 32.7 years, 78.4% male, anti-TNF agent user 16.7%) were included. Baseline QFT-G was positive in 426 (20.3%) patients, and 15 active tuberculosis was observed [Incidence rate 1.5/1000 person years (PY)]. Compared with baseline QFT-G (-) patients, baseline QFT-G (+) patients were older (41.2 years vs. 31.3 years, pThen we conducted subgroup analysis on 965 patients with baseline QFT-G (-) and follow-up QFT-G tests. Seroconversion was documented in 65 patients (6.7%). Active tuberculosis was observed in 4 patients, and seroconversion was occurred before the development of active tuberculosis in all patients. The incidence of active tuberculosis in seroconversion patients were 10.5/1000PY.Conclusion:QFT-G (+) and QFT-G seroconversion is associated with increased risk of the development of active tuberculosis in patients with AS.Figure 1.Overview of patient flowDisclosure of Interests:None declared

Objective The objective of this paper is to identify the prevalence, risk factors, and impact on mortality of neuropsychiatric systemic lupus erythematosus (NPSLE). Methods Patients from the Hanyang BAE lupus cohort were registered and followed from 1998 to 2015. NPSLE was defined using American College of Rheumatology (ACR) case definitions and Ainiala criteria. Demographics, autoantibodies, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and Systemic Lupus International Collaborating Clinic (SLICC)/ACR Damage Index were collected at baseline and then annually. Mortality data were derived by linking data from the Korean National Statistics Office. Multivariable logistic regression and Cox regression analysis were conducted in the inception cohort to assess the risk factors and mortality impact of NPSLE. Results Of 1121 registered patients, 429 (38.3%) had NPSLE manifestations according to ACR criteria and 216 (19.3%) by Ainiala criteria. In multivariable logistic regression analysis, higher SLEDAI (OR 1.08, CI 1.01–1.16, p = 0.02) and antiphospholipid antibody positivity (OR 1.72, CI 1.03–2.87, p = 0.04) at SLE diagnosis increased NPSLE risk, while elevated anti-dsDNA antibodies (OR 0.43, CI 0.24–0.78, p Conclusion Higher SLEDAI, antiphospholipid antibody positivity, absence of anti-dsDNA antibody at SLE diagnosis, and fewer years of education are risk factors for development of NPSLE. Presence of NPSLE, especially focal CNS NPSLE, increased the risk of mortality in SLE patients.

Objective To identify the incidence, risk factors and prognosis for neuropsychiatric lupus (NPSLE) in Korea. Methods 1121 patients with SLE from Hanyang BAE lupus cohort were enrolled and followed from 1998 to 2015. NPSLE was defined using the ACR case definitions and Ainiala Criteria. Demographics and clinical information including ACR Classification criteria for SLE, autoantibodies, SLE Disease Activity Index, the SLICC/ACR damage index (DI) were collected at baseline and then annually. Symptoms of NPSLE were collected from patient interview and medical records. Mortality data were derived by linking with data from the Korean National Statistics Office (KNSO). Multivariable logistic regression and cox regression test were performed to assess the risk factor of NPSLE and predictors of mortality. Results Of 1121 SLE patients, 429 (38.2%) patients had NPSLE events according to ACR definitions and 216 (19.3%) by Ainiala criteria. In multivariable logistic regression analysis, year of education [Odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87 to 0.96, p Conclusion The 38.2% and 19.3% of SLE patients had NPSLE according to ACR and Ainiala definition of NPSLE. Year of education and elevated anti-dsDNA antibodies decreased the risk of occurrence of NPSLE. SLEDAI without NP manifestations at enrollment increased the risk of mortality in NPSLE patients.

In the world of SNS, once ordinary users get recognized for discriminated fashion taste, they affect other users’ choice of fashion products. Fashion companies capture the importance of these influencers and tries to take advantage of their ability. However, the benefits offered to influencers such as financial compensation may provoke negative consumer reactions. The purpose of this study is to identify what aspects of SNS influencers and how they influence other fashion consumers. We suggest that influencers’ self-disclosure and authenticity of posts are important factors which elicit positive response from consumers. We also investigate the psychological mechanism of envy which can mediate the impact of self-disclosure and authenticity on consumer response. This study was conducted by an online survey of 120 Korean women in their 20s and 30s with a 2 x 2 between-group experimental design. The data was collected from 28 November to 5 December 2016. The collected data was analyzed using SPSS 23.0 for ANOVA analysis and regression analysis.The results were as follows. The main effect of authenticity was confirmed, while self-disclosure did not play a significant role, which indicates authenticity is the main factor in exercising influence on consumer response. The interaction of authenticity and self-disclosure was also observed. The participants of high in both self-disclosure and authenticity showed the strongest consumer reaction. However, the participants of high self-disclosure and low authenticity induced the weakest consumer response. For the impacts of self-disclosure and authenticity on envy, the participants exposed to the condition of both high self-disclosure and authenticity showed benign envy. On the other hand, malicious envy was aroused when both self-disclosure and authenticity were low. In relations between authenticity and consumer response, partial mediating effect of benign envy and malicious envy was confirmed. But, there was no mediating effect between self-disclosure and consumer response.This research on consumer response to influencers’ posts will provide key implications to fashion companies in building marketing strategies. In order for influencers' posts displaying their daily lives to have a positive impact on consumer response, not only self-disclosure but authenticity has to be considered. Such posts can induce benign envy and subsequently impact consumers indirectly. Influencers’ posts which narrow the gap between daily lives and products and raise the authenticity are important keys to successful marketing.

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC15C3388).