Background Rheumatoid arthritis (RA) and chronic kidney disease (CKD) are very prevalent and so often coincide. Among various anti-inflammatory agents, TNF-α blocking drugs reportedly stabilize renal function in RA patients with CKD and/or secondary renal amyloidosis by suppressing inflammation. However, there are no available data supporting the efficacy of anti-TNF-α agents in a larger population of RA patients with renal insufficiency. Objectives To investigate the impact of anti-tumor necrosis factor alpha (TNF-α) therapy on progression of CKD in patients with RA. Methods Seventy patients with RA and CKD were retrospectively analyzed. Outcomes were evaluated using the difference in the annual change of estimated glomerular filtration rate (eGFR) between patients with treated with anti-TNF-α or without. Results There was a tendency toward stabilization of eGFR after a median of 2.6 years (interquartile range, 1.2–4.2 years) from 50.3±8.4 ml/min/1.73 m2 to 54.5±16.0 ml/min/1.73 m2 in patients received anti-TNF-α therapy (p=0.084). Conversely, eGFR decreased significantly in patients not receiving anti-TNF-α therapy after a median of 3.0 years (interquartile range, 1.8–4.6 years) from 50.9±7.7 ml/min/1.73 m2 to 43.7±10.9 ml/min/1.73 m2 (p<0.001). The annual change of eGFR was significantly different between patients treated with anti-TNF-α drugs and without (2.0±7.0 ml/min/1.73 m2/y versus -2.9±5.8 ml/min/1.73 m2/y; difference in mean values, -4.9 ml/min/1.73 m2/y; 95% confidence interval, -7.5 to -2.2; p=0.002). Use of anti-TNF-α drugs was also significantly associated with positive annual change of eGFR in logistic regression analysis (p=0.009). Conclusions Among patients with RA and CKD, treatment with anti-TNF-α drugs was associated with less renal function decline. Anti-TNF-α drugs may be beneficial for managing RA combined with CKD. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4801

Background The epidemiologic studies of granulomatosis with polyangiitis (Wegener’s) (GPA) have been reported primarily in European/American countries while there are only a few data available from Asian area. Recent clinical studies from Japan and China indicated that there is a geographical difference in the incidence of GPA (1, 2) and the different ANCA pattern between Asian and Caucasian may be associated with different clinical manifestations. Objectives The aim of this study is to anlayze the clinicopathologic characteristics of Korean patients with GPA. Methods We retrospectively reviewed 45 patients with GPA regarding clinical manifestations including histology, positivity of ANCA, categorization of disease stages, disease activity states in a single tertiary referral hospital. Patients were categorized into a predominant form based on immunopathologic scoring system of granulomatous-vasculitic activity (3). Results Thirty-one patients (68.9%) showed ANCA positivity (C-ANCA/P-ANCA, 44.4%/20.0%, proteinase-3 (PR3) ANCA/myeloperoxidase (MPO) ANCA, 48.4%/16.1%). ANCA positive patients (female 29.6%) were associated with higher frequency of renal involvement (51.6% vs 7.1%, p=0.004), elevated serum creatinine (29.0% vs 0%, p=0.018) and higher mortality (29% vs 7.1%, p=0.041) compared with ANCA negative patients. Thirty-three patients (73.3%, female 60.6%) were categorized into a granulomatous form, whereas vasculitic form and mixed form were found in 8.9% and 17.8% respectively. Age at diagnosis were younger (51.2 vs 62.3, p=0.045), and initial remission rate (69.7% vs 25.0%) and the relapse rate (60.8% vs 0%) were higher in granulomatous form compared with vasculitic form. Conclusions Taken together, in Korean patients with GPA, ANCA positivity was found in 68.9% and associated with renal involvement and higher mortality. The granulomatous form was predominant. References Fujimoto S, Watts RA, Kobayashi S, Suzuki K, Jayne DR, Scott DGet al. Comparison of the epidemiology of anti-neutrophil cytoplasmic antibody-associated vasculitis between Japan and the U.K. Rheumatology (Oxford).2011;50:1916-20. Chen M, Yu F, Zhang Y, Zou WZ, Zhao MH, Wang HY. Characteristics of Chinese patients with Wegener’s granulomatosis with anti-myeloperoxidase autoantibodies. Kidney Int. 2005; 68: 2225-29. Pierrot-Deseilligny Despujol C, Pouchot J, Pagnoux C, Coste J, Guillevin L. Predictors at diagnosis of a first Wegener’s granulomatosis relapse after obtaining complete remission. Rheumatol. 2010;49: 2181-90. Disclosure of Interest None Declared

BackgroundSystemic lupus erythematosus (SLE) is a systemic autoimmune disease often characterised by the development of glomerulonephritis.1 There is a growing interest in the use of mycophenolate mofetil (MMF) as induction therapy and maintenance therapy for lupus nephritis.2, 3 ObjectivesThis study aimed to evaluate the therapeutic outcome of MMF in lupus nephritis from real-world clinical practice, and identify the predictors for failure of remission after MMF treatment.MethodsKorean patients with pathologically proven lupus nephritis class III, IV, and V were recruited from rheumatology clinic in Severance Hospital, Yonsei University College of Medicine between Nov 2011 and Aug 2017 Patients who treated with MMF for at least 3 months were included in the analysis. The probability of remission after MMF therapy, and the difference between patients who achieved remission or failed to achieve remission were analysed using Kaplan-Meier analysis and Cox proportional hazards model.ResultsOf 153 patients with lupus nephritis, 116 patients were included in this study. Seventy two patients continued MMF until the last follow-up. The mean age of patients was 34.2 years, and the median duration of SLE was 5.7 months. Anti-dsDNA antibody was positive in 82.8% of patients, and 9.5% of patients showed a histological class with pure V pathology. Mean protein/creatinine ratio in spot urine was 4.6, and active urinary sediment was found in 82.8% of patients. During median follow-up period of 5 years, 80% of patients achieved clinical remission of lupus nephritis. Median time to remission was 4.2 months (IQR 0.9–9.1). Risk factors for failure of remission were nephrotic-range proteinuria and seronegativity of anti-dsDNA antibodies.ConclusionsThis study shows the real-world data on MMF treatment in patients with lupus nephritis. Patients with risk factors for failure to remission may require more intensive treatment and management.References[1] Yu F, Haas M, Glassock R, Zhao MH. Redefining lupus nephritis: clinical implications of pathophysiologic subtypes, Nature reviews. Nephrology13 (2017) 483–495.[2] Ginzler EM, Dooley MA, Aranow C, Kim MY, Buyon J, Merrill JT, et al. Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. The New England journal of medicine2005;353(2005):2219–2228.[3] Dooley MA, Jayne D, Ginzler EM, Isenberg D, Olsen NJ, Wofsy D, et al. Mycophenolate versus azathioprine as maintenance therapy for lupus nephritis. The New England journal of medicine2011;365(2011):1886–1895.AcknowledgementsNoneDisclosure of InterestNone declared

ObjectivesTo determine the prevalence of foot synovitis, and the most stringent disease activity index reflecting complete remission among patients with rheumatoid arthritis in Korea.MethodsWe conducted a cross-sectional study using data from the Korean College of Rheumatology BIOlogics (KOBIO) registry. Foot arthritis defined as having one or more tender or swollen joints in ankle and/or 1st to 5th metatarsal joints. Functional status and disease activity evaluated by the routine assessment of patient index data3 (RAPID3), the disease activity score 28 ESR (DAS28), the simplified disease activity index (SDAI), the clinical disease activity index (CDAI), and the ACR/EULAR Boolean criteria.ResultsBaseline data of 2046 patients were analysed. Patients with foot arthritis showed significantly younger age at the diagnosis, longer disease, duration, higher DAS-28/SDAI/CDAI/RAPID-3, lower rate of ACR/EULAR Boolean criteria remission, use of higher dose of glucocorticoid, and higher rate of bone erosion not only on foot but also hand X-rays. Among those patients, 174 patients (8.5%) were in DAS 28 clinical remission. Twenty-one of 174 patients (12.1%) had foot arthritis, who showed higher swollen and tender joint count, RAPID-3 score, and patients’ global assessment but not physicians’ global assessment than those without foot arthritis. Among patients with foot arthritis, rate of complete remission was the highest in patients with CDAI (66.7%).ConclusionsIn patients with rheumatoid arthritis, foot and/or ankle arthritis is associated with high disease activity, not achieving complete remission despite of various clinical remission criteria and discordance between patients’ and physicians’ global assessment.Disclosure of InterestNone declared