Background Sarcoidosis is a multisystemic granulomatous disorder of uncertain etiology, which is rare in Asia. In particular, subcutaneous sarcoidosis is a specific cutaneous lesion of sarcoidosis that is rarely reported. Objectives The aim of this study is to evaluate the clinicopathological features of 18 pateints with specific subcutaneous sarcoidosis and their relationship with systemic feature of the disease. Methods All patients performed skin biopsy and diagnosed with subcutaneous sarcoidosis from 2003 to 2013 were reviewed. Histological finding and clinical characteristics were analyzed. Results Eighteen patients with specific subcutaneous sarcoidosis were observed. Mean age at diagnosis was 51.4 years and female were dominant (17 patients, 94%). The initial lesions of the patients were 12 infiltrated nodulopapule, 3 maculopapular eruption, and 2 scar sarcoidosis. Subcutaneous lesions were most frequently located in the extremities. Four (22.2%) of 18 patients demonstrated only specific cutaneous involvement during follow-up period and the rest of the patients presented systemic involvement which included 14 hilar and mediastinal lymphadenopathy with or wihout lung parenchymal lesion, 3 arthritis, 2 uveitis, or 1 splenic involvement. Serum angiotensin-converting enzyme level in patients with systemic involvement tends to be higher than those without, although there was no statistical significance. In most of the patients, subcutaneous nodules appeared at the beginning of the disease and only 3 cases present skin nodules within 6 months after diagnosis. Twelve (66.5%) patients were treated with oral steroid and 4 (22.2%) patients treated with hydroxychloroquine or colchicine. The nodules remitted spontaneously in less than 1 year in 2 patients. Three patients present relapse course with lung involvement and were treated with oral steroid with azathioprine, which showed partial remission. Conclusions Specific subcutaneous sarcoidosis is a quite uniform clinicopathological entity usually appearing at the beginning of the disease. It may present with nonsevere systemic involvement and showed favorable clinical outcome. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5278

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 clinical data on the biologic disease-modifying antirheumatic drug (bDMARD) use in late-onset ankylosing spondylitis (LOAS) is limited. Thus, this study aimed to evaluate the drug efficacy and retention rate of bDMARDs in LOAS and compare it to young-onset ankylosing spondylitis (YOAS).Methods: Data of patients with AS receiving bDMARDs were extracted from the Korean College of Rheumatology Biologics and Targeted Therapy registry. Patients whose age of onset was > 50 years and < 50 years were classified as having LOAS and YOAS, respectively. Their baseline characteristics and disease-associated parameters were evaluated. Drug efficacy (Ankylosing Spondylitis Disease Activity Score [ASDAS]-clinically important improvement [CII], ASDAS-major improvement [MI], Assessment of SpondyloArthritis International Society [ASAS] 20, and ASAS 40) at 1-year follow-up and drug retention rates were assessed. Results: A total of 1708 patients (comprising 1472 patients with YOAS and 236 patients with LOAS) were included in this analysis. The LOAS group had a lower prevalence among males, lower HLA-B27 positivity and a higher prevalence of peripheral arthritis. Patients with LOAS were more likely to have higher disease-associated parameters (inflammatory reactants, patient global assessment, ASDAS-erythrocyte sedimentation rate, and ASDAS-C-reactive protein). LOAS was negatively associated with achieving ASDAS-CII, ASAS 20, and ASAS 40. The drug retention rate was lower in LOAS; however, the propensity score-matched and covariate-adjusted hazard ratios for bDMARD discontinuation were comparable to YOAS. There were no differences in the drug retention rates based on the type of bDMARD used in LOAS. Conclusion: Inferior clinical efficacy and drug retention rates were found in patients with LOAS receiving bDMARDs using real-world nationwide data. There were no differences among each bDMARD type.

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BackgroundDetermining the optimal, patient-tailored biologic agent is a new challenge for future guidelines in rheumatoid arthritis (RA) management. Recent studies demonstrated that anti-citrullinated protein antibody (ACPA) -positive patients have better disease activity improvement with abatacept (ABA), yet validation studies are in need.ObjectivesTo investigate disease activity changes after treatment with ABA versus TNF inhibitors (TNFi) in Korean ACPA-positive, RA patients.MethodsData of RA patients were obtained from the Korean College of Rheumatology Biologics Registry (KOBIO). ACPA-positive patients who were treated with ABA and TNFi were selected through propensity score matching (1:2, calliper=0.2*SD). Clinical outcomes including CDAI changes at the first year of therapy were evaluated, and adjusted drug survival in each group was analysed.ResultsThe baseline characteristics of the ABA (n=97) and TNFi (n=194) groups were comparable. The CDAI reduction after 1 year treatment was significant in the ABA group compared with patients who received TNFi (−16.78 versus −13.61, p=0.0198) [figure 1]. This was confined when used as the first-line agent (p=0.0213). Proportion of remission and low disease activity in ABA was significant as well (p=0.041). Patients with the lower tertile of ACPA titers treated with ABA had the most significant CDAI reduction compared with the TNFi group (p=0.0201). Drug retention rate (median follow-up 48 months) of ACPA-positive ABA users was also notable compared with TNFi yet did not meet statistical significance (adjusted hazard ratio 0.774, p=0.086).ConclusionsOur data further support that ACPA could also be an important marker to help determine first-line biologic agent of choice among the armamentarium of biologic therapy for RA patients.AcknowledgementsWe would like to thank Song Wha Chae and Evo Alemao for their input and support.Disclosure of InterestNone declared