Objective To describe the radiographic phenotype of axial spondyloarthritis (SpA) according to the presence of HLA–B27. Methods An international collaboration compared the radiographic phenotype of axial SpA according to HLA–B27 status. Patients with ankylosing spondylitis (AS) and axial psoriatic arthritis (PsA) were collected. Radiographs were read centrally, blinded to clinical details. The symmetry of the sacroiliac joints and lumbar syndesmophytes and the morphology of syndesmophytes (typical marginal versus atypical chunky), together with the modified Stoke Ankylosing Spondylitis Spine Score and the Psoriatic Arthritis Spondylitis Radiographic Index, were recorded. Results A total of 244 patients with PsA and 198 patients with AS were included. In PsA, 60 patients (25%) were HLA–B27 positive while in AS, 148 patients (75%) were HLA–B27 positive. Patients with HLA–B27 were younger and more often male and had a longer duration of disease. In multivariable logistic regression, HLA–B27 was significantly associated with syndesmophyte symmetry (odds ratio [OR] 3.02 [95% confidence interval (95% CI) 1.38, 6.61]) and marginal syndesmophytes (OR 1.97 [95% CI 1.16, 3.36]) but not with sacroiliac symmetry. Mean radiographic scores were higher for patients with HLA–B27. Conclusion Patients with axial SpA who are positive for HLA–B27 have more severe radiographic damage, more marginal syndesmophytes, and more frequent syndesmophyte symmetry compared to patients who are negative for HLA–B27.

BackgroundIt has been described a higher prevalence of metabolic syndrome (MetS) in patients with spondyloarthitis (SpA), particularly in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).ObjectivesTo describe the prevalence of MetS in SpA patients identifying associated factors and to make a comparison between patients with AS and PsA.MethodsObservational and retrospective study of 410 SpA patients (188 AS according to modified New York criteria and 222 PsA according to CASPAR criteria) belonging to our follow-up cohort (2004-2014) of northwest of Spain. Demographic, clinical and laboratory data were collected corresponding to baseline visit. MetS was defined according to Adult Treatment Panel III (ATPIII) criteria. Qualitative variables were analyzed using Chi-square/Fisher test and for quantitative variables we used Student t/U Mann Whitney test. Statistical analysis was performed by SPSS 21.0 program. It was considered p<0.05 as significant.ResultsOf the 410 patients, 68.3%, 280 were men (78% in AS and 60% in PsA, p<0.001), the mean age was 50 (±14) years without differences between AS and PsA. We could determine the prevalence of MetS in 287 patients; 37% (107) SpA patients fulfilled ATPIII criteria (47% in PsA versus 24% in AS, p<0.001). The percentages of each item considered in ATP III criteria are exposed in table 1. We observed differences in high levels of blood glucose (32% in PsA and 16% in AS, p<0.001) and high blood pressure (72.2% in PsA and 61.7% in AS, p 0.035). MetS was related with male sex, high age and body surface mass (BMI), hyperuricemia and peripheral forms in the overall sample (p<0.05). In AS MetS was related with higher BASDAI and higher tragus-wall distance. Introducing significant and clinically relevant variables in the multivariate analysis, MetS was related with sex male (OR 4.9, CI 95% 1.85-12.79, p 0.001), higher BMI (OR 1.2 CI 95% 1.11-1.30 p<0.001) and PsA diagnosis (OR 2.7 CI 95% 1.12-6.51 p 0.027).MetS ATP III items*% SpA patientsBlood glucose >100 mg/dl25%Triglycerides >150 mg/dl or treatment26%HDL cholesterol <40 mg/dl male/>50 mg/dl female or treatment19%Abdominal circumference >102 cm male/>88 cm female74%Blood pressure >130/85 mmHg68%*A minimum of three items has to fulfill to diagnose MetS.ConclusionsWe demonstrate an elevated prevalence of MetS in SpA patients; that is higher in PsA than in AS patients. These results highlight the importance of detection and early treatment of cardiovascular risk factors in SpA patients.Disclosure of InterestNone declared

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Background AS and PsA patients without clinically evident cardiovascular disease have a high prevalence of subclinical cardiovascular disease in form of increased carotid intima-media thickness (IMT) and carotid plaques compared to matched controls. Objectives To evaluate subclinical atherosclerosis by determining carotid IMT and the presence of atheromatous plaques in a sample of patients with PsA and AS, and analyze its relationship with demographic, clinical and analytical characteristics. Methods Observational and cross-sectional study of 70 spondyloarthritis patients (40 PsA according to the CASPAR classification criteria and 30 AS patients According to the New York classification criteria) were randomly selected from our cohort in 2013. We recorded age and sex of patients, disease duration, joint count, VAS for pain and for global disease activity, BASDAI and BASFI score, ESR, CRP, HLA-B27 and Cw0602, CV risk factors as systolic and diastolic blood pressure, smoking status, glycemia, lipid profile and BMI. IMT (mm) and carotid plaques were measured in the right common carotid artery and the study was performed using high-resolution B-mode ultrasound. Continuous variables were compared using Student's t-test or Mann-Whitney U test. Proportions were compared by chi-square test or Fisher's exact test. Correlation between carotid IMT and continuous variables was tested via estimation of Pearson's partial correlation coefficient adjusted by age at the time of the study. Two-sided P values less than 0.05 were considered to indicate statistical significance. Statistical analysis was performed with the SPSS 17.0 program. Results Carotid IMT was correlated with age (rho =0.444, p<0.0001), abdominal circumference (r =0.409, p=0.001) and CRP level (r =0.496, p=0.001). Uveitis was associated with higher IMT (0.74 vs 0.62, p=0.046). Also high blood pressure was associated with higher IMT (0.73 vs 0.59, p=0.02). Atheromatous plaques were present in around 10% of patients and were associated with higher IMT (p=0.040). All the other variables were not significantly associated with IMT. Patients with PsA had slightly greater carotid artery IMT than AS (0.67 vs 0.60, p=0.076). Conclusions In our patients with SAp the carotid intima-media thickness is associated with older age, presence of atheromatous plaques, hypertension, obesity, higher C-reactive protein serum levels and uveitis. References Gonzalez-Juanatey C, Llorca J, Amigo-Diaz E, Dierssen T, Martin J, Gonzalez-Gay MA. High prevalence of subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors. Arthritis Rheum. 2007 Aug 15; 57(6):1074-80 Gonzalez-Juanatey C, Vazquez-Rodriguez TR, Miranda-Filloy JA, Dierssen T, Vaqueiro I, Blanco R, et al. The high prevalence of subclinical atherosclerosis in patients with ankylosing spondylitis without clinically evident cardiovascular disease. Medicine (Baltimore) 2009; 88: 358–65 Acknowledgements We wish to express our enor...