The aims of this study are to analyse the characteristics of septic arthritis stratified by age and to identify the predictors of treatment failure and mortality in septic arthritis. A retrospective single-centre study was conducted in patients with native septic arthritis between 1994 and 2012. The primary outcome was treatment failure. Secondary outcomes included mortality, complications, endocarditis, bacteraemia, hospital readmission and the duration of the hospital stay. Logistic regression analyses with a propensity score were performed to identify the predictors of response and mortality. Additional analyses were performed according to age and the initial treatment (surgery or conservative). A total of 186 patients were studied. The median (interquartile range) age was 64 (46, 74) years, and the percentage of male patients was 68.9%. A logistic regression analysis showed that Staphylococcus aureus infection [OR 2.39 (1.20-4.77), p = 0.013], endocarditis [OR 4.74 (1.16-19.24), p = 0.029] and the involvement of joints difficult to access with needle drainage [OR 2.33 (1.06-5.11), p = 0.034] predict treatment failure and that age [OR 1.27 (1.07 = 1.50), p = 0.005], the leucocyte count at baseline [OR 1.01 (1.00-1.02), p = 0.023], bacteraemia [OR 27.66 (1.39-551.20), p = 0.030], diabetes mellitus [OR 15.33 (1.36-172.67), p = 0.027] and chronic renal failure [OR 81.27 (3.32-1990.20), p = 0.007] predict mortality. No significant differences in treatment failure by age were found. In septic arthritis, the predictors of mortality and the predictors of treatment failure differ. The predictors of treatment failure concern local factors and systemic complications, whereas conditions related to the host's immune competence, such as age and comorbidities that hamper the host's response, predict mortality.

Objective To assess the efficacy and safety of abatacept (ABA) in monotherapy (ABAMONO) versus combined-ABA, ABA plus methotrexate (ABAMTX) or ABA plus non-MTX conventional-DMARDs (ABANON-MTX), in Rheumatoid Arthritis (RA) patients with Interstitial Lung Disease (ILD) (RA-ILD). Methods Restrospective multicenter study of RA-ILD Caucasian patients treated with ABA. We analyzed in the three groups (ABAMONO, ABAMTX, ABANON-MTX) the following outcome variables: a) Dyspnea b) FVC and DLCO c) chest HRCT, d) DAS28-ESR, e) corticosteroid-sparing effect, f) ABA retention and side-effects. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the three groups. Results We studied 263 RA-ILD patients (mean age 64.6±10 years) [ABAMONO (n = 111), ABAMTX (n = 46) and ABANON-MTX (n = 106)]. At baseline, ABAMONO patients were older (67±10 years) and took higher prednisone dose (10 [IQR 5-15] mg/day). At that time, there were no statistically significant differences in sex, seropositivity, ILD patterns, FVC and DLCO or disease duration. Following treatment, in all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnoea, chest-HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in corticosteroid-sparing effect in the group on combined-ABA (ABAMTX or ABANON-MTX). However, in the multivariable analysis, there were no differences in any outcome variables between the three groups. Conclusion In Caucasian individuals with RA-ILD, ABA in monotherapy or combined with MTX or with other conventional-DMARDS seems to be equally effective and safe. However, a corticosteroid-sparing effect is only observed with combined-ABA.

Background: Interstitial lung disease (ILD) associated with Rheumatoid Arthritis (RA) has a poor prognosis. Treatments such as anti-TNF, have been implicated in the exacerbation of an ILD. Objectives: Our objective is to evaluate and compare the evolution of ILD in patients with RA treated with Abatacept (ABA), Rituximab (RTX) and Tocilizumab (TCZ) after 1 year of treatment. Methods: Retrospective multicentre study of patients with ILD and AR treated with ABA, RTX and TCZ at standard doses. The ILD was diagnosed by CT. Conclusions: There seems to be a trend towards a better radiological response in patients treated with RTX and ABA. It would be necessary prospective studies. Background: Approximately a third of Rheumatoid Arthritis (RA) patients treated with tumour necrosis factor (TNF)-a inhibitors such as Infliximab (IFX) fail to respond. This has prompted a widespread interest in the finding of measures for predictors of response to TNFa inhibitors. Objectives: To search for serum autoantibodies that aid to identify RA patients most likely to benefit from IFX. Methods: We analysed serum of 170 biologic-naïve RA patients at baseline assigned to receive IFX plus methotrexate. The serum samples were distributed in 3 independent samples sets that were provided by 3 different sources: 1 discovery sample set (n=24) collected from Hospital Clínico Universitario of Santiago de Compostela (Spain) and 2 validation sample sets collected from Hospital Universitario de A Coruña (Spain), (n=61); and the Swedish Farmacotherapy (SWEFOT) trial (Sweden), (n=85). The European League Against Rheumatism (EULAR) criteria were used to assess the clinical response at six months of follow-up: good response (GR, n=60), moderate (MR, n=60) and non-response (NR, n=50). A suspension bead array platform built on protein fragments within Human Protein Atlas and selected from an initial screening using an array containing 42 000 antigens was employed to identify the IgG and IgA autoantibodies in the discovery sample set and validate the results within the 2 validation sets. Thresholds for autoantibodies were calculated by Receiver Operating Characteristics (ROC) curve analysis performed with SPSS 24. Results: Our data revealed a more prevalent IgG reactivity and higher IgG autoantibody levels against the antigen Centromere Protein F (CENPF) in GR when compared with NR, showing an overall reactivity of 31% vs 0%, 45% vs. 26% and 17% vs 4% in the three sample sets analysed respectively. The area under the ROC curve was 0,649 [p-value=0.049; IC 95% (0.510-0.789)]. CENP-F is a proliferation-associated and cell cycle-dependent centromere autoantigen that might be involved in the increased or abnormal cell proliferation that occurs during RA process. Interestingly, our results also showed that IgA autoantibodies levels toward the antigen Solute Carrier family 39 member 2 (SLC39A2), a zinc transporter protein, were decreased in GR when compared with MR in the discovery sample set and this trend was significantly validated (p=0.018) in the SWEFOT c...

BackgroundRheumatoid arthritis (RA) may associate with Interstitial Lung Disease (ILD). Disease-modifying anti-rheumatic drug (DMARD) or TNF alfa inhibitors (iTNF), had been involved in the ILD development as well as exacerbation of an existing one. Nowadays there is no consensus related to treatment.ObjectivesThe aimed of this study is to evaluate efficacy and safety of Abatacept (ABA) treatment in patients with AR and ILD.MethodsMulticentre study in patients with RA and ILD associated were treated with ABA. ILD was diagnosed by High Resolution Computed Tomography (HRCT). ABA was used at dose of 10 mg/kg/4 weeks iv or 125 mg/week sc. Its efficacy was evaluated according to the following measures:a) Dyspnea classified by the Modified Medical Research Council (MMRC); Significant variability of 1 point and asymptomatic MMRC=0;b) Pulmonary function test (PFT); Significant oscillations >10% in Forced Vital Capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO) >10%;c) Imaging technique (HRCT);d) Joint assessment (DAS28).Quantitative variables were expressed as mean ± SD or as median (interquartile range) and compared with (Wilcoxon test) (Test Fisher) between the baseline and 3, 6 and 12 months.Results34 individuals were included (19 women /15 men), patients with ILD associated to RA, with a mean age of 61,4 ± 9,8 years. The median duration of RA before ADA was initiated was 4,8 [0,86–13,12] (0–25) years, and had previously received an average 1,29±0,90 DMARDs. RA was seropositive in 24 cases (71%). ILD was associated with a DMARD: MTX (n=3), Etanercept (n=3), Adalimumab (n=3) y Certolizumab (n=1).ABA was used in monotherapy in 14 patients and combined with other immunosuppressors in 20 patients: Leflunomide (LFD) (n=7), LFD and cyclosporine (n=1), Sulfasalazine (n=1), MTX (n=2), MTX with LFD (n=1), hydroxychloroquine (n=5), Hydroxychloroquine with LFD (n=2), Azathioprine (n=1).A significant improvement of dyspnea was observed; patients who didn't have dyspnea, kept asymptomatic. FVC and HRCT showed a significant improvement during 6 to 12 months period. DLCO remained stable in the majority of the patients. RA (DAS28) activity also improved.After follow up of 12,82±7,48 months, the most significant adverse effects were: pulmonary Infection (n=2), urinary infections (n=1), infusion reactions (n=1).ABA was discontinued due to: Serious infections (n=2); join inefficacy (n=2), pulmonary inefficacy (n=1), infusion reaction (n=1).ConclusionsABA seems to be an effective and relatively safe treatment in patients with RA and associated ILD. This data should be verified again in prospective and randomized studies.Disclosure of InterestNone declared

BackgroundDisease modifying antirheumatic drugs (DMARDs) such as methotrexate (MTX), leflunomide (LFN) or antiTNFα have been implicated in development/exacerbation of Interstitial lung disease (ILD)of rheumatoid arthritis (RA). Several radiological patterns of ILD have been described: i) usual interstitial pneumonia (UIP), ii) nonspecific interstitial pneumonia (NSIP), iii) obliterating bronchitis (OB), and iv) Organized pneumonia (OP)ObjectivesTo assess the response to Abatacept (ABA) in these patterns of ILDMethodsMulticenter study of RA-ILD treated with ABA. ILD was diagnosed by high-resolution CT scan (HRCT) and classified in radiological patterns (Travis et al). We consider 3 subgroups: a) UIP, b) NSIP and c) “other” (OB, OP or mixed). ABA was used at iv or sc standard dose. We assessed: a) Dyspnea (Medical Research Council-modified scale; significant variations≥1); B) Respiratory function tests; significant changes≥10% in forced vital capacity (FVC) and DLCO≤10%, c) HRCT, d) DAS28. A comparative study was performed for the quantitative (U-Mann-Whitney) and qualitative variables (Fisher test) between the baseline and 3, 6 and 12 months.ResultsWe included 63 patients (27 women/36 men), mean age; 63.1±9.6 years. At ABA onset the RA had a median evolution of 6.8 [2–13.6] years and the ILD of 1 [0.3–3.03]. RA was seropositive in 85.7%. The diagnosis of ILD was confirmed by biopsy (n=18). The ILD was related to DMARDs: MTX (4), etanercept (3), adalimumab (3), certolizumab (2), Infliximab (1). ABA was used in monotherapy (26) or combined with other DMARDs (37); LFN (15), Cyclosporin (1), sulfasalazine (4), MTX (6), hydroxychloroquine (10), azathioprine (4), chloroquine (1). Table 1 shows the evolution in the available cases. A significant improvement in dyspnea and HRCT was observed in the NIU type. DLCO remained stable in most patients regardless of the radiological pattern. The activity of RA (DAS28) also improved.Table 1ConclusionsABA appears to be effective in ILD associated-RA, including the pattern of poor prognosis (UIP).References Travis WD et al. J Respir Crit Care Med 2013 188:733–748. Disclosure of InterestNone declared