ObjectivesThe relationship between osteoarthritis (OA) and osteoporosis has exhibited contradictory features over the past four decades. The aim of this study was to evaluate this relationship using separate analysis of the radiographic features of OA whether various radiographic features of OA were associated differently with bone mineral density (BMD) in the Korean elderly.MethodsData were derived from the Dong-gu cohort; 2,354 subjects were enrolled in the present cross-sectional study. Baseline characteristics, the BMDs of the lumbar spine and femoral neck which was measured by DXA, and X-rays of knees and hands, were collected. A semi-quantitative grading system was used to estimate the severities of individual radiographic features. We adjusted for confounders using multiple linear regression modeling to analyze the relationships.ResultsAfter adjustment for confounders, hand and knee OA total scores were negatively associated with the BMDs of the lumbar spine and femoral neck, except for the total knee OA score and lumbar spine BMD. In detail, hand osteophytes and sclerosis exhibited positive relationships with the BMDs of the lumbar spine and femoral neck, except for hand osteophytes and femoral neck BMD. On the contrary, however, knee joint space narrowing (JSN), hand JSN, and hand subchondral cysts were negatively associated with the BMD of the lumbar spine and femoral neck. Knee JSN and hand subchondral cysts exerted the greatest effects on BMD.ConclusionsSeparate analysis of the radiographic features of OA better reveals associations of OA with the BMD of the lumbar spine and femoral neck.Disclosure of InterestNone declared

BackgroundAllopurinol-induced severe cutaneous adverse reactions (SCARs) are relatively rare, but cause high rates of morbidity and mortality. Studies have shown that the HLA-B5801 allele and renal impairment are strongly associated with SCARs. Recent American College of Rheumatology guideline recommends that, prior to treatment with allopurinol, the HLA–B5801 genotype of gout patients at high risk for SCARs, including Korean patients with chronic renal insufficiency, should be determined. However, whether such genotyping is cost-effective is unknown.ObjectivesIn this study, we evaluated the cost-effectiveness of HLA-B5801 genotyping for treatment of gout in patients with chronic renal insufficiency in Korea.MethodsA decision analytic model over a time period of 12 months was employed to compare the cost and outcomes of treatment informed by HLA-B5801 genotyping with that of a conventional treatment strategy using a hypothetical cohort of gout patients with chronic renal insufficiency. Direct medical costs were obtained from real SCAR patients from two tertiary hospitals. Outcomes were measured as a total expected cost and an incremental cost-effectiveness ratio.ResultsIn the base model, the total expected cost and probability of continuation of gout treatment without SCARs with the conventional and HLA-B5801 screening strategies were US $1,193 and US $1,055, and 97.8% and 100%, respectively. The result was robust according to sensitivity analyses.ConclusionsOur model suggests that gout treatment informed by HLA-B5801 genotyping is less costly and more effective than treatment without genotyping, and HLA-B5801 genotyping could considerably reduce the occurrence of allopurinol-induced SCARs and related deaths.Disclosure of InterestNone declared

ObjectivesThe survival rate of patients with systemic lupus erythematosus (SLE) has improved in the last few decades, but the rate of hospitalization and health care costs for these patients remain higher than in the general population. Thus, we evaluated the rate of hospitalization and associated risk factors in an inception cohort of Korean patients with lupus.MethodsOf the 507 patients with SLE enrolled in the KORean lupus NETwork (KORNET registry), we investigated an inception cohort consisting of 196 patients with SLE presenting within 6 months of diagnosis based on the ACR classification criteria. We evaluated the causes of hospitalization, demographic characteristics, and laboratory and clinical data at the time of SLE diagnosis of hospitalized patients and during a follow-up period. We calculated the hospitalization rate as the number of total hospitalizations divided by the disease duration, and defined “frequent hospitalization” as hospitalization more than once per year.ResultsOf the 196 patients, 117 (59.6%) were admitted to hospital a total of 257 times during the 8-year follow-up period. Moreover, 22 (11.2%) patients were hospitalized frequently. The most common reasons for hospitalization included disease flares, infection, and pregnancy-related morbidity. In the univariate regression analysis, malar rash, arthritis, pericarditis, renal involvement, fever, SLE disease activity index >12, hemoglobin level <10 mg/dl, albumin level <3.5 mg/dl, and anti–Sjögren's syndrome A (SS-A) positivity were associated with frequent hospitalization. Finally, multivariate analysis showed that arthritis, pericarditis, and anti–SS-A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization.ConclusionsOur results showed that frequent hospitalization occurred in 11.2% of hospitalized patients and arthritis, pericarditis, and anti–SS-A antibody positivity at the time of diagnosis were risk factors for frequent hospitalization.Disclosure of InterestNone declared

Objectives To investigate whether the presence of germinal center (GC) in minor salivary glands of patients with Sjögren's syndrome (SS) is associated with different clinical and laboratory features. Methods Minor salivary gland tissue biopsies from 93 SS patients were used to identify GC-like structures and germinal center was confirmed by CD21-positive follicular dendritic cell networks. Sociodemographic, glandular, and extraglandular manifestations, and laboratory findings including autoantibodies, complement, and immunoglobulin levels, were analyzed. EULAR SS disease activity index (ESSDAI) and SS disease damage index (SSDDI) were also measured. Results GC-like structures were observed in 28 of 93 SS patients (30.1%). Mean focus score was significantly higher in GC-positive patients than in GC-negative patients. GC-positive patients had higher CRP levels and had higher prevalence of rheumatoid factor, anti-CCP antibody, and anti-SSA/Ro antibody compared to GC-negative patients. However, glandular and extra-glandular manifestations were not different between the two groups. Conclusions Our findings showed that SS patients who had GC-like structures in minor salivary glands had different laboratory profiles compared to those patients who didn't have. Long-term follow-up of these patients will be necessary to see whether these laboratory abnormalities translate into changes in clinical features. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2681

Background Up to 30-40% of patients with systemic lupus erythematosus (SLE) experience their onset prior to adulthood or at over 50 years of age. Patients with juvenile-onset SLE (JSLE) frequently present with severe organ involvement and higher disease activity at the onset of disease. In contrast, patients with late-onset SLE (LSLE) tend to show more insidious onset and mild initial clinical manifestations. However, few studies have investigated differences in clinical manifestations with disease onset in Asian lupus patients. Objectives Thus, we investigated whether SLE patients could be distinguished based on the time of disease onset and, if so, whether the groups differed in their clinical and laboratory features in ethnically homogeneous Korean patients. Methods We enrolled 201 SLE patients (mean age 34.1±12.7, 184 women) with available clinical data at the time of onset of SLE from the lupus cohort at Chonnam National University Hospital. Sociodemographic, clinical, and laboratory data, including autoantibodies, and concomitant diseases were found at the time of diagnosis of SLE by reviewing the patient charts. We divided SLE patients according to age at SLE diagnosis into three groups: JSLE (diagnosed at ≤18 years), adult-onset SLE (ASLE, diagnosed at 19-50 years), and LSLE (diagnosed at >50 years), and compared baseline demographic, clinical, and relevant laboratory findings. Data were analyzed using the chi-squared test for categorical variables and one-way ANOVA test for continuous variables. Results Of the 210 patients, 27 (14.4%), 149 (74.1%), and 25 (12.4%) were JSLE, ASLE, and LSLE patients, respectively. Fever, oral ulcer, nephritis, anemia, and thrombocytopenia were more common in JSLE patients than ASLE or LSLE patients (p<0.05, p<0.05, p=0.001, p<0.05, and p<0.05, respectively). On the other hand, Sjögren's syndrome was found more frequently in LSLE patients than JSLE or ASLE patients (p<0.05). SLEDAI-2000 scores at the onset of SLE were 14.6±7.1 in JSLE, 11.1±6.1 in ASLE, and 6.6±2.7 in LSLE, and disease activity was significantly higher in JSLE patients than in ASLE or LSLE patients (p<0.001). Anti-dsDNA and anti-nucleosome antibodies were found more frequently in JSLE patients and less frequently in LSLE patients (p<0.05, p=0.005) and decreased complement levels (C3, C4, and CH50) were more common in JSLE patients and less common in LSLE patients (p<0.001, p<0.001, and p<0.05, respectively). Conclusions Our results showed that SLE patients present with different clinical and serological manifestations according to age at disease onset. JSLE patients have severe disease activity and more frequent renal involvement and LSLE patients have mild disease activity, more commonly accompanied by Sjögren's syndrome, at disease onset. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2686