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A 26-year-old woman presented with abdominal pain, diarrhoea, vomiting, fever, and progressive paralysis in the lower limbs. She had a history of bronchial asthma and experienced sinusitis, progressive peripheral neuropathy, polyarthritis, and leukocytosis with prominent eosinophilia. The patient was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA). Abdominal pain was considered to be an ischaemic enteritis associated with EGPA. She was administered 1,000 mg/day of methylprednisolone for 3 days and intravenous immunoglobulin (400 mg/kg/day of γ-globulin for 5 days) followed by 50 mg (1 mg/kg)/day of oral prednisolone due to rapidly progressing peripheral neuropathy. Her symptoms temporarily improved; however, peripheral neuropathy recurred after a week, and the eosinophil count increased. Eighteen days after following the resumed treatment, 300 mg of mepolizumab, a humanised monoclonal antibody, was administered. Subjective symptoms, nerve conduction velocity, and skin perfusion pressure (an index of peripheral circulation in the lower extremities) improved after 4 weeks. Although mepolizumab has been approved for EGPA, there is no evidence of its efficacy against peripheral neuropathy. Early introduction of mepolizumab may contribute to an the early improved progressive peripheral neuropathy with eosinophilia.

Objective.The risk of clinically manifested major cardiovascular (CV) events in primary Sjögren syndrome (pSS) remains unclear. This study aimed to assess myocardial fibrosis in pSS and investigate the associated disease characteristics by cardiac magnetic resonance imaging (cMRI).Methods.We performed a cross-sectional study of patients with pSS without cardiac symptoms. Labial gland biopsy was documented in 44 patients (85%). Patients without CV risk factors underwent contrast-enhanced cMRI. Late gadolinium enhancement (LGE) was used to assess myocardial fibrosis. Myocardial edema was assessed using T2-weighted imaging (T2WI). We compared the left ventricular (LV) geometry and function between the groups with and without LGE. Further, we explored the associations of cMRI abnormalities with pSS characteristics.Results.Fifty-two women with pSS (median age 55, IQR 47.0–65.7 yrs) were enrolled in the study. LGE was observed in 10 patients (19%), two of whom showed high intensity on T2WI. High intensity on T2WI was observed in 3 patients (5.8%). LV mass index and LV mass/end-diastolic volume tended to be higher in the LGE-positive group than in the LGE-negative group (P = 0.078 and 0.093, respectively). Salivary gland focus score (FS) ≥ 3 was independently associated with LGE-positive in the multivariable analysis (OR 11.21, 95% CI 1.18–106.80).Conclusion.Subclinical myocardial fibrosis, as detected by cMRI, was frequent in patients with pSS without cardiac symptoms. Abnormal cMRI findings were associated with salivary gland FS ≥ 3.

Conventionally, some patients with methotrexate-associated lymphoproliferative disorder (MTX-LPD) undergo spontaneous tumour regression after cessation of MTX. Although the involvement of Epstein-Barr virus (EBV) in the development and spontaneous regression has been suggested, the underlying mechanism remains unknown. In this study, we analysed patients who had developed MTX-LPD to evaluate the association between the development and spontaneous regression of MTX-LPD with EBV.We analysed the age, stage, disease activity, MTX dose, lymphocyte count, EBV real-time polymerase chain reaction (PCR) test value, and EBV-encoded small RNA (EBER) positivity rate in patients with MTX-LPD at our hospital. Moreover, we investigated the factors related to spontaneous regression, which is a characteristic of MTX-LPD.Thirty-four patients were enrolled in this study. The MTX dose at LPD onset was 8.3±2.0 mg/week, and the total dose of MTX was 1,530.3±779.2 mg. The EBV load in the peripheral blood was 270.4±431.8 copy/μL, and the pathological tissues of 17 of 34 (50%) patients tested positive for EBER. Twenty-one patients had spontaneous regression after discontinuation of MTX. The factors related to spontaneous regression were examined using a univariate analysis, and the EBV real-time PCR test value in the peripheral blood, EBER in pathological tissues, and improvement rate of lymphocyte count were considered significant factors. The EBV real-time PCR test value in the peripheral blood was defined as an independent factor of spontaneous regression using a multivariate analysis of related factors.EBV may be involved in the development of MTX-LPD and its spontaneous regression.

AIM To evaluate left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA) and to determine the impact of biological treatment on LV function in these patients using global circumferential strain (GCS), global longitudinal strain (GLS) and global radial strain (GRS) values assessed by feature tracking cardiac magnetic resonance (FT-CMR) imaging. METHODS Eighty patients with RA and 20 controls without cardiovascular disease underwent non-contrast CMR imaging. Patients with RA received conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic DMARDs (bDMARDs). Global strains were calculated in 16 LV segments. RESULTS No significant differences in cardiovascular risk factors were found between the RA group and controls. GCS was 21% lower in the RA group compared with controls (P < 0.001) and was 14% lower in the csDMARDs group compared with the bDMARDs group (P = 0.002), whereas, there was no significant difference in GLS and GRS between the RA group and the controls. In regard to strain rates, diastolic GCS and GRS rates were significantly lower in the RA group (P

Aim This study aimed to evaluate the association between myocardial abnormalities and left ventricular (LV) geometry as assessed using cardiac magnetic resonance imaging (CMRI) in systemic sclerosis (SSc) patients without cardiac symptoms. Methods SSc patients without cardiac symptoms or cardiovascular risk factors underwent contrast CMRI. CMRI were assessed for structural and functional LV parameters and myocardial fibrosis based on myocardial late gadolinium enhancement (LGE). The correlation between brain natriuretic peptide (BNP) levels and LGE status was evaluated. Results Among 49 patients, 27 (55%) showed LGE positivity. The most common identified LGE pattern was a linear pattern. LGE was not consistent with coronary artery distribution. There was no difference in ejection fraction between those with and without LGE. LV morphological changes were observed in 29% of SSc patients. An abnormal LV structure was detected in 44% and 14% of patients in the LGE+ and LGE- groups, respectively. The BNP levels were higher by 57% in the LGE+ group than in the LGE-group. Receiver operating characteristic analysis showed that BNP levels reliably detected myocardial abnormalities (area under the curve, 0.72; 95% confidence interval 0.58-0.88). Conclusions Myocardial abnormalities were common in SSc patients without cardiac symptoms. We suggest that LV morphological changes may have resulted from myocardial abnormalities. BNP may be useful as a screening tool for the detection of myocardial abnormalities in SSc patients.

We report a 68-years-old woman with systemic sclerosis and interstitial pneumonia (IP). She had developed subacute progressively encephalopathy and dementia while treated with oral cyclophosphamide and prednisolone. She admitted to our hospital because of syncope. Laboratory tests indicated slight elevated cerebrospinal fluid protein, and levels of serum C-reactive protein (CRP), levels of soluble IL-2 receptor was normal. But, magnetic resonance imaging (MRI) of the brain showed multiple infarct-like lesions mainly in the white matter, which mimics progressive multiple leukoencephalopathy (PML). Twenty days after admission, the retested MRI of the brain disclosed initial lesions progressively enlarged and numbers of the lesions were increased. The polymerase chain reaction (PCR) for JC virus of cerebrospinal fluid was negative. To make diagnosis, brain biopsy was performed. Microscopic examination revealed that small vessels were filled with lymphoma cells (CD20+, CD79+, CD3-), and intravascular lymphoma (IVL) was diagnosed. She treated with regimens of R-CHOP. After chemotherapy her consciousness and dementia were gradually improved. IVL of central nerve system (CNS) is a rare disease, and its common symptoms are ischemia, infarction and dementia. Diagnosis of IVL of CNS is difficult when the lesion mimics PML, and patient with similar laboratory examinations and radiographic findings of PML should undergo brain biopsy detected malignant cell in small vessels, which is a value of diagnosis.

Objectives Minodronic acid hydrate, an oral bisphosphonate, has a greater inhibitory effect on bone resorption than do other approved drugs; however, this has been studied only in patients with primary osteoporosis. Here, we administered minodronic acid hydrate to patients with steroid-induced osteoporosis who have been treated with steroids for rheumatoid arthritis or other collagen diseases, and the efficacy and safety of minodronic acid hydrate were prospectively investigated. Methods Twenty-five patients treated in our rheumatology clinic received minodronic acid hydrate 1 mg/day. The changes in bone mineral density (BMD) and bone turnover markers were investigated at 3 and 6 months, and adverse events, including the presence or absence of an incident osteoporotic fracture, were examined over a period of 6 months. Results Percent changes in BMD of the lumbar spine and femur significantly increased. The values of bone turnover markers significantly decreased. There were no patients with a radiographically apparent incident fracture. Adverse events included toothache for which the patient discontinued the treatment and three cases of gastrointestinal disorder that did not lead to discontinuation, and thus minodronic acid hydrate was well tolerated. Conclusions Here, we show that minodronic acid hydrate is effectively and safely used for treatment of steroid-induced osteoporosis.

Background Primary Sjogren syndrome (pSS) shares many clinical, inflammatory, and immunological features with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Both SLE and RA are characterized by a high risk of cardiac involvement. However, there are limited data on the risk of overt cardiac involvement in pSS. Objectives We sought to use a cardiac magnetic resonance imaging (CMR) approach to assess cardiac involvement and determine its association with disease characteristics in pSS patients without cardiac symptoms. Methods Consecutive pSS patients, according to ACR classification criteria (2012), without a history or clinical findings of hypertension, cardiovascular disease, diabetes, or dyslipidemia underwent contrast CMR. Late gadolinium enhancement (LGE) was used for the assessment of myocardial fibrosis. Using a black-blood T2-weighted image (T2-WI), myocardial inflammation could be assessed. Sjogren syndrome disease activity index (ESSDAI) was determined. Eighty percent patients had documentation of a minor salivary gland biopsy. Salivary gland biopsy data were classified by focus score (FS). We investigated the patients in terms of prevalence of CMR abnormalities and explored possible associations between CMR abnormalities and pSS disease characteristics. Results Thirty-seven female pSS patients were enrolled (mean age: 55.5 ± 7.0 years). On an average, cardiovascular risk was low for the group, with patients demonstrating no ECG abnormalities, and the patients had generally low traditional cardiovascular risk factors, with a mean Framingham 10-year hard cardiovascular risk score of 4 ± 2%. The mean ESSDAI was 3.3 ± 2.1. Thirteen patients (35%) demonstrated myocardial abnormalities. Myocardial edema was seen in 5 patients (13%) on T2-WI. LGE was found in 11 patients (29%), 3 of whom demonstrated edema on T2-WI. The main finding observed in 7 among 11 LGE-positive patients (63%) was a linear LGE pattern without coronary distribution. A patchy nodular LGE pattern was observed in 4 among 11 patients (37%). The patients with CMR abnormalities showed no significant difference of ESSDAI, compared with those with no CMR abnormalities. Antibodies to La/SSB antigens were significantly higher in LGE-positive than LGE-negative patients (p=0.003). Raynaud phenomenon was significantly associated with LGE-positive and T2-WI-positive patients (p=0.001 and p=0.04, respectively). Other pSS characteristics such as disease duration, commodities, and cardiovascular risk factors were not significantly associated with myocardial abnormalities. The greatest relative difference between LGE-positive and -negative patients was observed in FS >3, with an adjusted odds ratio of 3.0. After adjusting for confounding by age, pSS duration, and anti-SSB antigen, the association of LGE with Reynaud phenomenon remained significant (p=0.02). Conclusions Subclinical myocardial involvement, as detected by CMR, was frequent in pSS patients without cardiac symptoms. Our results suggest that Raynaud phenomenon has a role in promoting cardiac involvements in patients with pSS. Disclosure of Interest None declared

Background Individuals with rheumatoid arthritis (RA) are at a 2-fold increased risk of sudden death compared with age- and gender-matched controls without RA. Although mechanisms underlying the increased risk are yet unclear, evidence indicates effects of systemic inflammation on ventricular repolarization. Accordingly, corrected QT (QTc) interval prolongation is more frequent in patients with RA than in those without RA. A previous pilot study reported that tocilizumab (TCZ) normalizes the QTc interval by dampening systemic inflammation. Objectives Our study prospectively evaluates TCZ treatment effects on the QTc interval of patients with RA without cardiac symptoms and explores the association between this QTc interval and RA disease activity and severity measures. Methods This prospective interventional study was conducted between March 2012 and August 2015 at the Itabashi Chuo Medical center. Patients who fulfilled the American College of Rheumatology (ACR) RA classification criteria or the 2010 ACR/ European League against Rheumatism RA criteria were included. Exclusion criteria included diabetes, history of cardiovascular events, hypertension (systolic blood pressure (BP) >140 mm Hg and/or diastolic BP >90 mm Hg), dyslipidemia (LDL cholesterol levels >140 mg/dL, HDL cholesterol level 150 mg/dL), cardiomyopathy, renal disease, and current atrial fibrillation. Age- and gender-matched healthy controls without any cardiac symptoms were selected. Patients with active RA with inadequate clinical response to methotrexate (MTX) were administered tocilizumab (TCZ 8 mg/kg IV every 4 weeks or 162 mg SC biweekly). Electrocardiography and clinical and biological monitoring were performed at baseline and 24 weeks after TCZ treatment in patients with RA. Results Ninety patients with RA (mean age: 56.4±10.4 yers; 85% female) and 40 age and gender matched healthy controls (mean age 55.6±3.4 years; 86% female) were included, of which 20% and 13% of RA patients received antihypertensive and antihyperlipidemia therapy, respectively. No significant differences were observed in mean Framingham 10 scores between healthy controls and patients with RA at baseline. The 24-week Simplified Disease Activity Index scores were significantly lower than those at baseline. Using previously established cutoffs (440 ms), we identified 8 (10%) patients with abnormal QTc interval prolongation. However, QTc intervals at baseline were higher in patients with RA than in controls (mean SD 420.3 ± 35.8 msec, mean SD 411 ± 31.2 msec; p=0.04). The QTc interval decreased by 20.9 msec from baseline to 24 weeks (p=0.001) following TCZ treatment. QTc interval prolongation at baseline was significantly correlated with the anticyclic citrullinated peptide antibody (ACPA) at baseline (p=0.003). ACPA at baseline (p=0.001) was associated with %change in QTc interval. Furthermore, no significant associations between QTc interval and RA activity were observed. Conclusions Tocilizmab treatment in patients with RA decreases QTc interval. Furthermore, anti-arrhythmic potential of TCZ treatment may have beneficial effects in patients with RA. Our results provide further evidence regarding the close association between ACPA degree and QTc intervals. Disclosure of Interest None declared

Background Individuals with rheumatoid arthritis (RA) have a twofold higher risk of developing sudden death than age and gender matched controls without RA. The underlying mechanisms have not yet been clarified. Objectives The aim of this study was to prospectively investigate the association of myocardial involvement assessed by a cardiac magnetic resonance imaging (CMR) and the QTc interval in RA without cardiac symptoms. Methods RA patients and control subjects with no history and/or clinical findings of systemic and pulmonary hypertension, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, and dyslipidemia were enrolled and underwent CMR. RA patients received conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic DMARDs (bDMARDs). Late gadolinium enhancement (LGE) was obtained for the assessment of myocardial fibrosis. Using a black-blood T2-weighted image (T2-WI), myocardial inflammation could be assessed. The QTc intervals were manually measured on a 12-lead electrocardiogram, according to standard criteria. The QTc interval of 440 ms was considered to be prolonged in this study. We compared the patients and controls in terms of prevalence of CMR abnormalities and the QTc interval, and explored possible associations between CMR abnormalities and the QTc interval. Results Sixty-seven patients (mean age, 54.2 ± 1.7 years; 89% female) and 30 controls (mean age 53.6 ± 2.5 years; 87% female) were enrolled. Thirty-one RA patients received csDMARDs [25, methotrexate (MTX) (9.7±2.1 mg); 7, other drugs)] and 36 RA patients received bDMARDs [(15, infliximab; 15, tocilizumab; 6, abatacept, plus MTX respectively. (9.6±1.4 mg)]. The control group showed no myocardial abnormalities. Twenty seven RA patients (40%) demonstrated myocardial abnormalities. T2-WI was seen in seven RA patients (10%). LGE-positive was found in 20 RA patients (30%), six of whom also demonstrated T2-WI. All RA patients and control patients displayed a normal QTc interval. However, there was significant difference in the QTc interval between the control and LGE-positive (p=0.013). Also LGE-positive was significant higher in the QTc interval than LGE -negative. LGE-positive was associated with the QTc interval. The use of bDMARDs was significantly associated with LGE-negative findings (p=0.001) and the QTc interval. (p=0.001). High titer of anticitrullinated protein antibodies was associated with the QTc interval (p=0.04). Receiver operating characteristic analysis showed the QTc interval reliably detected myocardial abnormalities (area under the curve 0.898; 95% confidence interval, 0.830–0.900). Considering patients with RA and a normal QTc interval and using a cutoff of 420 ms, sensitivity and specificity were 91% and 70% in the detection of myocardial abnormalities. Conclusions Subclinical myocardial inflammation and fibrosis are common in active RA patients without cardiac manifestation. Abnormal CMR findings were associated with a QTc interval. Even if the QTc interval is normal, we should keep in mind the possibility of subclinical myocardial involvement in RA. Disclosure of Interest None declared

Background Polymyositis (PM) and dermatomyositis (DM) are inflammatory diseases; up to 70% affected patients (pts) show cardiac involvement, which may be fatal. However, the diagnosis, based on electrocardiogram, laboratory, and imaging investigations, is difficult because of nonspecific clinical presentation and the lack of standardized criteria. Cardiac magnetic resonance (CMR) is currently the best technique for diagnosing cardiac fibrosis and inflammation. Objectives To evaluate cardiac involvement in PM/DM pts without cardiac manifestations by using CMR. Methods Sixteen consecutive female PM/DM pts (age, 51.9±11.0 years; 7 DM, 9 PM) and 16 gender/age-matched healthy controls without cardiac symptoms (age, 52.6±5.3 years) underwent CMR. Pts and control subjects had no history and/or clinical findings of systemic/pulmonary hypertension, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, and dyslipidemia. Late gadolinium enhancement (LGE) was considered to indicate myocardial fibrosis, and black-blood T2WI was used for assessing myocardial inflammation. Left ventricular geometry was classified into concentric remodeling, concentric hypertrophy, eccentric hypertrophy, or normal. We compared the pts and controls regarding prevalence of CMR abnormalities, and explored the possible associations between CMR abnormalities and PM/DM disease characteristics. Group comparisons were made using the Wilcoxon chi-square test, Tukey–Kramer test, and Fisher exact test. Results PM/DM pts had normal inflammatory indices (erythrocyte sedimentation rate, C-reactive protein level), muscle enzyme assays, and improved muscle strength tests. LGE and T2WI were similar between PM and DM. LGE was seen in 8 pts (50%). Three of these 8 pts also had positive T2WI. Enhancement patterns observed were linear in middle layer, linear in subepicardial layer, nodular in middle layer, and patchy in middle layer (3, 1, 3, 1 pts, respectively). T2WI was observed in the same areas with LGE. No difference LGE positivity and T2WI findings was observed between PM (56% and 11%, respectively) and DM (43% and 29%, respectively) pts. Ejection fraction (EF) was similar between pts and controls (p=0.23). Of note, 7 pts showed concentric remodeling, and 75% of these pats showed LGE. PM/DM pts had higher NT-proBNP levels than controls. LGE was significantly correlated with concentric remodeling in PM/DM pts (p=0.04). Anti-Jo1 Ab positivity was correlated with LGE (p=0.03). However, T2WI was not associated with disease characteristics. Adjustment for disease duration, anti-Jo1 Ab, and LGE did not modify the association with concentric remodeling. Conclusions PM/DM pts without cardiac symptoms have a high prevalence of cardiac abnormalities. PM/DM pts with LGE are associated with abnormal morphology even with normal EF. Moreover, anti-Jo1 Ab positivity may be associated with LGE. Further studies are needed to determine whether CMR abnormalities affect prognosis or treatment strategy. Disclosure of Interest None declared

Background Systemic sclerosis (SSc) has an increased prevalence of cardiac involvement despite often being clinically silent. When clinically evident, cardiac involvement decreased the 70% 5-year mortality of SSc. Cardiac magnetic resonance imaging (CMR) is useful in SSc beause it focuses on late gadolinium enhancement (LGE) abnormalities and ventricular morphology and function. Objectives We aimed to assess the prevalence of subclinical myocardial involvement by left ventricular (LV) function and structure on CMR. We evaluated the relation between myocardial abnormalities and LV geometry. Methods This study compared consecutive female SSc patients without cardiac symptoms and healthy female controls with no history or clinical findings of systemic and pulmonary hypertension by echocardiography, coronary artery disease, valvular heart disease, atrial fibrillation, diabetes mellitus, and dyslipidemia. All underwent non-contrast or contrast CMR on a 3.0-T scanner. LV function was measured using ejection fraction (EF), end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), and cardiac output (CO). LV hypertrophy was measured by absolute LV mass (LVM) and LVM index (LVMI) determined by LVM/body surface area. LGE was obtained to assess myocardial fibrosis. Myocardial inflammation was assessed by black- blood T2WI. Serum BNP concentrations were measured simultaneously. Results There were 44 SSc patients with a mean age of 57.1±8.7 years; 20 had diffuse type and 24 had limited type. There were 20 healthy controls with a mean age of 56.9±3.1 years. There were no significant differences in terms of age, gender, and cardiovascular risk factors. Compared with the control, SSc patients had a significantly higher EDV with tendency towards a high LVMI. There was no difference in EF. LGE (+) was detected in 25 of 44 (57%) SSc patients; LGE was in a linear pattern without coronary distribution in 13 (52%) SSc patients. T2WI was observed in 11 of 44 (25%) SSc patients. There were no differences in LGE and T2WI between the diffuse and limited type. The BNP level of the SSc group was significantly higher than that of the control group (P=0.04). The mean BNP level of SSc patients with LGE was significantly higher than that of SSc patients without LGE (P Conclusions SSc patients without cardiac symptoms have a high prevalence of cardiac abnormalities. Our data suggest that SSc-specific autoimmunity against Scl-70 mediates these changes. SSc patients with LGE had cardiac abnormalities associated with LVMI and serum BNP, leading to cardiac remodeling and possible development of cardiac involvement, even with a normal EF. Disclosure of Interest None declared

Background Patients with rheumatoid arthritis (RA) have a 1.5–2.0 fold higher risk of developing congestive heart failure than the general population. Small increases in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels predict left ventricular (LV) dysfunction, and the LV myocardium is the primary site of NT-proBNP production. Data relating to the effects of interleukin (IL)-6 blocking agents on circulating NT-proBNP levels in patients with active RA are lacking but may be informative. To our knowledge, there are no published reports regarding the effect of tocilizumab (TCZ) treatment on NT-proBNP levels. Objectives To test the hypothesis anti-IL-6 therapy might reduce circulating NT-proBNP levels. Methods RA patients with active disease without a clinical diagnosis of cardiovascular disease (CVD) and with an inadequate clinical response to DMARDs were enrolled. The patients received TCZ once a month after 24 weeks. Serum NT-pro BNP levels were measured on the Cobas 6000 modular analyzer simultaneously on stored baseline and 24-week samples, and NT-pro-BNP levels ≥100 pg/mL were considered elevated. We explored the associations between NT-pro BNP and the RA disease activity score for 28 joints: erythrocyte sedimentation rate (DAS28-ESR) and Simple Disease Activity Index (SDAI) scores. The anti-citrullinated protein antibody (ACPA) titre was divided into high and low levels using a cut-off of 30 units/mL. Correlations between the biomarkers and changes in circulating NT-proBNP levels were evaluated using the Spearman rank test, and multivariable linear regression analyses of the correlates were performed. Results Sixty RA patients (mean age, 60.4±10.4 years; 75% female) were enrolled. The DAS28-ESR and SDAI at baseline were 4.57±1.35 and 22.5±12.7, respectively. The 24-week DAS28-ESR and SDAI scores were significantly lower than those at baseline (p=0.04, p=0.03, respectively). The NT-proBNP levels at baseline were approximately 31% higher than normal levels, and the median (interquartile range) levels significantly decreased from baseline (131.78 [52.81–230.24] pg/mL) to 24 weeks (57.13 [29.50–128.67] pg/mL, p=0.004) following TCZ treatment. The change in NT-proBNP levels was significantly correlated with the change in the SDAI score and swollen joints count (SJC) ( r =0.455, p=0.003, r =0.395, p=0.004, respectively). The baseline NT-proBNP levels in the high ACPA group tended to be higher than in the low ACPA group (p=0.07). After adjustment for age, gender, ESR, and RA duration, the association between the change in NT-proBNP levels and the change in SJC remained significant (p=0.023). Conclusions The NT-proBNP level was higher than normal in patients with active RA without CVD; this may indicate subclinical left ventricular dysfunction. Furthermore, our results indicate the NT-proBNP levels decreased by approximately 38% with TCZ treatment, which was related to a reduction in disease activity. Therefore, TCZ treatment may directly influence the anti-inflammatory effect of IL-6 on the myocardium. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2189

Background One of the criteria for Sjogren9s syndrome (SS) is focal lymphocytic infiltration in minor salivary gland biopsy (MSGB). Few studies have revealed that the proportion of patients with focus score ≥1 (FS≥1) in SS and even in the dry mouth (DM) group. Objectives To diagnose SS using the 2012 American College of Rheumatology (ACR) classification criteria for SS, to assess MSGB, and to investigate pathological features, such as FS≥1. Methods Patients underwent MSGB from September 2009 to November 2013 at one institution. The indications for MSGB included the presence of DM symptoms and serological features. Regardless of connective tissue disease (CTD) before FS evaluation, patients who met the ACR criteria were divided into: Group I, primary SS; Group II, secondary SS; Group III, secondary DM; or Group IV, primary DM (Table). We investigated the correlation between FS≥1 and the diagnosis, and the correlation of the predictor with FS≥1. Statistical analyses were performed using the Fisher9s exact or Mann-Whitney tests, Bonferroni multiple comparisons, and multivariate analysis. These analyses were conducted for patients with rheumatoid arthritis (RA) and those with a CTD other than RA. Results MSGBs were performed on 192 patients (93% female); those with lymphoma, IgG4-related disease, and graft-versus-host disease (7 patients) were excluded. There were 185 patients with SS and DM, including primary SS (82), secondary SS (38), DM with CTDs (22), and DM without CTDs (43). The CTDs included RA (29), systemic lupus erythematosus (15), mixed CTD (3), myositis (6), and systemic sclerosis (8). The classification of the 185 patients by diagnosis and FS≥1 is shown in the Table. More patients in Groups I and II had FS≥1 (P 0.08). Among the 29 RA patients, 24 had FS≥1, but SS was confirmed in 14 patients only. The numbers of RA patients with FS≥1 in both secondary SS and secondary DM group were not significantly different (P=0.134). However, among patients with CTDs other than RA, the number of patients with FS≥1 in the secondary SS group was significantly different from that in the secondary DM group (P=0.005). Even RA patients with FS≥1 were assigned to DM group. Conclusions Pathologically, FS≥1 are useful for diagnosing SS. A significant number of patients with FS≥1 was found in both the SS and DM groups. However, patients with noncharacteristic SS may also have RA. Consequently, this study suggests especially the necessity of further investigation and follow-up studies in RA patients who showed inconsistent results with the ACR criteria for DM symptoms. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2684