BackgroundRheumatoid factor (RF) is an autoantibody directed against the Fc component of IgG. It is present in approximately 70-80% of rheumatoid arthritis (RA) patients but also found nonspecifically in chronic inflammatory condition such as sarcoidosis, hepatitis B or C, and tuberculosis. Meanwhile, in relation to RA-related autoantibodies, airways abnormalities were reported in patients without inflammatory arthritis and the lung has been suggested as a potential site of generation of RA-related autoimmunity. In subjects without any specific medical problem, however, the influence of RF to lung function is infrequently known.ObjectivesThis study aimed to determine the effect of the presence of RF on pulmonary function in a large number of Korean healthy subjects without any history of joint disease and clinically apparent lung diseases.MethodsOf the 114,944 people who participated in a health checkup program in 2010, 94,438 subjects with normal chest radiography were recruited, whose results of RF and pulmonary function test (PFT) using spirometry were available. Subjects with arthralgia or the past medical history of arthritis including RA, and lung diseases were excluded based on self-reported questionnaire. Association between RF and PFT was assessed by correlation analysis.ResultsAmong 94,438 people, RF was positive in 3,326 subjects (3.52%). Their mean age was 41.3±8.3 (range, 21 – 83) and 43.8% were female; these characteristics were not significantly different from those of RF-negative subjects, whose mean age was 41.3±8.3 (range, 18 – 88) and 43.7% female. Ever-smokers (ex- and current smokers) were 39% in RF-positive subjects while 41.2% in RF-negative subjects (p=0.009). Hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibodies (anti-HCV) were more frequently seen in RF-positive subjects (12.1% vs. 3.5%, p<0.001 for HBsAg and 0.5% vs. 0.1%, p<0.001 for anti-HCV). Regarding PFT, RF-positive subjects had lower forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) compared to RF-negative subjects (3.79±0.83 L vs. 3.87±0.83 L, p<0.001 and 3.17±0.66 vs. 3.25±0.67 L, p<0.001). The proportion of subjects with FVC below 82% and FEV1 below 84% of the predicted value was significantly higher in RF-positive subjects (50.7% vs. 46.6%, p<0.001 and 54.5% vs.49.4%, p<0.001) but the frequency of airflow limitation (FEV1/FVC ≤70%) did not differ between two groups (1.4% vs. 1.5%, p=0.47). FVC and FEV1 had negative correlations with the RF titers and the strength was very weak (r = -0.053, p<0.001 in FVC and r = -0.055, p<0.001 in FEV1).ConclusionsThe results suggest that RF could impact on lung function in healthy subjects without clinically apparent lung diseases. A follow up study for the serial changes of PFT may reflect the actual influence of the raised RF titers.Disclosure of InterestNone declared

BackgroundHyperuricemia is particularly common in patients with chronic kidney disease (CKD). Its role, however, as a risk factor for renal outcomes of CKD is debated and those data in gout patients with CKD are rare.ObjectivesThis aim of study was to evaluate long-term effect of serum uric acid (SUA) level on progression of CKD in gout patients with uric acid lowering treatment.MethodsAll patients who had a first visit for gout with CKD at Samsung Medical Center between 1995 and 2003, and follow-up until December 2012 or expired during follow-up period were included and retrospective analyzed. CKD was defined as an estimated glomerular filtration rate GFR) of <60 mL/min/1.73m2 via the Modification of Diet in Renal Disease Study equation more than 3 months according to the Kidney Disease Outcome Quality Initiative CKD classification. All serum creatinine and matched SUA taken during follow-up period were analyzed by using mixed effect model to determine the effect of SUA level on renal outcome.ResultsOne-hundred eleven gout patients with CKD were observed. The mean age of the patients at diagnosis of gout was 51.3 and mean follow-up duration was 13 years. Baseline estimated GFR and serum creatinine were 47.7 mL/min/1.73m2 and 1.62 mg/dL, respectively. Eight (7.2%) patients revealed CKD stage 4 and the rest of patients (92.8%) were CKD stage 3. Maintaining the SUA below 6 mg/dL showed protective effect on serum creatinine and estimated GFR compared with maintaining SUA more than 6 mg/dL (p <0.0001 and p =0.02, respectively). The elevation of SUA as a continuous variable was also related to poor renal outcome in gout patients with CKD (p <0.0001). This effect of SUA on progression of CKD was not changed after adjusting for duration of gout and age at baseline, time-dependent hypertension, diabetes mellitus, hyperlipidemia, obesity, intrinsic renal diseases, and obstructive renal diseases. In particular, for every 1 mg/dL increase of the SUA, serum creatinine revealed to be increased by 0.019 mg/dL in group with SUA more than 6 mg/dL. Hypertension, diabetes mellitus and intrinsic renal disease were independent risk factors for progression of CKD in gout patients (p <0.0001, p <0.0001 and p =0.014, respectively).ConclusionsOur long term follow-up data demonstrated the SUA level was independent risk factor for progression of CKD in gout patients with uric acid lowering treatment. Maintaining of SUA level below 6 mg/dL would be essential to protect renal function in gout patients with CKD.Disclosure of InterestNone declared

ObjectivesThis study aimed to evaluate the clinical characteristics and associated factors of hip arthritis in patients with ankylosing spondylitis (AS).MethodsA retrospective analysis evaluated 488 patients of AS with hip arthritis at a single tertiary hospital in South Korea. Hip arthritis was assessed by Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-h) and the average joint space width of the hip joint at three distinct sites that are in between the acetabulum and femoral head at baseline and last visit of outpatient clinic. Clinical and laboratory characteristics were collected.ResultsAmong 488 patients with AS, 60 (12.3%) patients had hip arthritis. Body mass index (BMI) and erythrocyte sedimentation rate (ESR) were associated with hip involvement in AS (OR 1.11, 95% CI 1.03 to 1.19, p=0.008 and OR 1.01, 95% CI 1.00 to 1.02, p=0.005, respectively). The mean X-ray follow-up duration was 81.4±35.7 months. During the follow-up period, ESR and C-reactive protein (CRP) decreased significantly and there was no significant radiographic change in the hip joints. Among 60 patients, 7 (11.7%) patients had radiographic progression of the hip joints and 5 (8.3%) patients had hip replacement surgery. The BMI tended to be higher in patients with radiographic progression of the hip joints than in those without (23.4±4.2 vs. 26.6±3.9, p=0.068).ConclusionsMost of the patients with hip arthritis in AS had no significant radiographic progression during the follow-up period. BMI was associated with hip involvement in patients with AS.Disclosure of InterestNone declared

Background Pediatric-onset SLE (pSLE) represents 10-20% of all SLE patients, and several studies suggest that SLE tends to be more severe in pSLE than in adult-onset SLE. However, the impact of age or puberty at disease onset in children remains unclear and has rarely been studied. Objectives To evaluate the association between pubescent status and the initial presentation of pSLE. Methods Patients with a diagnosis of SLE before the age of 16 years and followed up at Jeju National University Hospital from 2003 to 2013 were eligible for inclusion in this study. Patients were divided into two groups, based on pubertal stage (> Tanner stage II) and/or menarche at diagnosis, defined as pre-pubescent and pubescent. Medical records regarding demographic profile, clinical and laboratory manifestations at diagnosis, SLE Disease Activity Index (SLEDAI) at diagnosis were reviewed. Results Forty-two patients with pSLE were included in this study: 36 girls (85.7%) and 6 boys (14.3%). The median age at diagnosis was 12.4 years (range 7.8 to 15.6 years). The cohort of pre-pubescent patients consisted of 9 girls and 5 boys (83.3% in boys), and the most of pubescent patients were girls (27, 96.4% in pubescent). Pre-pubescent patients showed significantly more hematologic and constitutional manifestations at diagnosis compared with pubescent patients, but musculoskeletal, cutaneous, and neurologic involvement occurred more frequently in pubescent patients. Renal involvement, complement level, and autoantibodies at diagnosis were not significantly different between the two cohorts. Pubescent patients showed a significantly higher disease activity score than pre-pubescent patients. Conclusions Although the number of patient was so small, these results suggest that the disease activity at diagnosis in pSLE significantly increased after pubescent and the distinct differences in the initial presentation between pre-pubescent and pubescent patients relate to musculoskeletal, cutaneous, and neurologic manifestations. References Silverman E, Eddy A. Systemic lupus eythematosus. In: Cassidy JT, Petty RE, Laxer RM, Lindsley CB, editors, Textbook of Pediatric Rheumatology. 6th ed. Philadelphia: Elsevier Saunders, 2011; 315-43. Descloux E, Durieu I, Cochat P, Vital-Durand D, Ninet J. Influence of age at disease onset in the outcome of paediatric systemic lupus erythematosus. Rheumatol 2009;48:779-84. Hui-Yuen JS, Imundo LF, Avitabile C, Kahn PJ, Eichenfield AH, Levy DM. Early versus later onset childhood-onset systemic lupus erythematosus: Clinical features, treatment and outcome. Lupus 2011;20:952-9. Malattia C, Martini A. Paediatric-onset systemic lupus erythematosus. Best Prac Res Clin Rheumatol 2013;27:351-62. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4172

Background The role of serum uric acid as an independent risk factor for cardiovascular disease (CVD) remains unclear, although hyperuricemia is associated with CVD such as ischemic heart diseases (IHD), cerebrovascular accidents (CVA), or peripheral arterial occlusive diseases (PAOD). In particular, no study showed long-term cumulative effect of serum uric acid on CVD in gout patients with treatment. Objectives The aim of this study is to evaluate long-term cumulative effect of serum uric acid on CVD and determine predictive factors of CVD in gout patient with uric acid lowering treatment. Methods All patients who had a first visit for gout at Samsung Medical Center between 1995 and 2003, and follow-up until December 2012 or expired during follow-up period were included and retrospective analyzed. Cox regression according to level of control of uric acid defined as time-dependent covariate of each uric acid level and the ratio of numbers of uric acid level more than 6 umol/l to total numbers of measured uric acid level was performed to assess the effect of long-term cumulative uric acid level on CVD in gout patients with treatment. Results Three-hundred twenty seven patients with gout were observed. Mean age at diagnosis of gout was 45.7 and mean follow-up duration was 14.1 years. Of these, 67 (20.5%) patients developed CVD during follow-up period, which included 34 IHD, 28 CVA, and 5 PAOD. CVD related death was observed in 10 patients (3.1%). Mean duration of gout at diagnosis of CVD was 13.3 years. For every 1 umol/l increase of uric acid level, the risk of CVD revealed to be increased 1.32-fold after adjusting age, smoking, family history of premature CVD, obesity, chronic kidney disease, time-dependent diabetes mellitus, hypertension, and hyperlipidemia (adjusted HR 1.32 (1.17-1.48), p<0.0001). In particular, the patients who had high proportion of events of uric acid over 6 umol/l was associated with increased CVD risk (adjusted HR 3.82 (1.08-13.56), p=0.037). Subgroup analysis by Cox regression showed that time-dependent uric acid level is related to increase the risk of IHD and severe CVD (adjusted HR 1.42 (1.23-1.64) p<0.001 and adjusted HR 1.33 (1.77- 1.33 (1.17-1.50), p<0.0001, respectively). Age at diagnosis of gout, family history of premature CVD, and diabetes mellitus were significantly associated with increased risk of CVD (adjusted HR 1.11 (1.02-1.06), p<0.0001, 13.30 (7.52-23.52), p<0.0001, and 2.65 (1.35-5.18), p=0.005, respectively). Conclusions Our data demonstrated serum uric acid level was associated with increased risk of CVD in gout patients with treatment, which is a first data determined the long-term cumulative effect of uric acid on CVD. To control hyperuricemia is important to prevent CVD beyond gout itself in patients with gout. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4817