The 2010 ACR/EULAR criteria were slightly more sensitive, but otherwise performed similarly to the older criteria. A high percentage of 'non-RA' patients used methotrexate, the gold standard for RA. The ability of the new criteria to identify patients with erosive disease was low, possibly owing to the effect of intensive treatment.

Objective To determine the relationship between gout flare rate and self-categorization into remission, low disease activity (LDA), and patient acceptable symptom state (PASS). Methods Patients with gout self-categorised as remission, LDA, and PASS, and reported number of flares over the preceding 6 and 12 months. Multinomial logistic regression was used to determine the association between being in each disease state (LDA and PASS were combined) and flare count and self-reported current flare. A distribution-based approach and extended Youden index identified possible flare count thresholds for each state. Results Investigators from 17 countries recruited 512 participants. Remission was associated with a median recalled flare count of zero over both 6 and 12 months. Each recalled flare reduced the likelihood of self-perceived remission compared with being in higher disease activity than LDA/PASS by 52% for 6 months and 23% for 12 months, and the likelihood of selfperceived LDA/PASS by 15% and 5% for 6 and 12 months, respectively. A threshold of 0 flares in preceding 6 and 12 months was associated with correct classification of self-perceived remission in 58% and 56% of cases, respectively. Conclusion Flares are significantly associated with perceptions of disease activity in gout and zero flares over the prior 6 or 12 months are necessary for most people to self-categorise as being in remission. However, recalled flare counts alone do not correctly classify all patients into selfcategorised disease activity states, suggesting that other factors may also contribute to selfperceived gout disease activity.

BackgroundEosinophilic Fasciitis is a rare scleroderma-like connective tissue disorder. No treatment has shown to be effective in randomized trials. The treatment most often reported is combination of moderate to high-dose glucocorticoids (1–1,5mg/kg/day) with weekly methotrexate (MTX), up to 25mg, but often with disappointing results.1,2ObjectivesTo examine the effect and safety of monthly intravenous (IV) high dose MTX in patients wtih eosinophilic fasciits.MethodsPatients with biopsy proven eosinophilic fasciits and progression of skin involvement, who were either treatment naïve or not responsive to glucocorticoids and MTX were included in this open prospective study. Treatment consisted of IV pulse MTX 4 mg/kg/month for 6 doses in 5 consecutive months. Twenty-four hours after the administration of MTX, 5mg folinic acid was orally taken every six hours, to a maximum of 25 mg/day. Patients were evaluated monthly, prior to every infusion. Primary outcome measure was the absolute improvement at month 5 compared to baseline of the modified skin score (mSS), according to Zachariae.3 Secondary outcome measures were durometer scores, Range of Motion (RoM) and Visual Analogue Scale (VAS) scores for disease activity by physician and patient and Short-Form-36.ResultsBetween 2006 and 2009, 12 patients were included and the median monthly MTX dose was 288mg (range 252–336). The median mSS improved from 17.5 [range 8.0–24.0] at baseline to 8.5 [range 1.0–20.0] at 5 months (p=0.001) (Fig 1). Compared to baseline, secondary outcome measures improved significantly, except for durometer scores and the range of motion of the elbows. There was no significant difference in skin improvement between the treatment naïve and non-naïve patients (p=0.968). After the last dose of IV MTX, EF flared in six patients after a median of 2 months (range 2–5). A second cycle with IV MTX (3 pulses) was administered to these 6 patients, with a favourable response in all patients. One patient was withdrawn due to increased liver enzymes (2 – times upper limit of normal) after 5 administrations, which normalized after MTX withdrawal. Gastro-intestinal symptoms were present in the majority of the patients (n=9), but manageable with anti-emetics.ConclusionsHigh dose IV MTX could be an effective and safe treatment option in patients with eosinophilic fasciitis.ReferencesLebeaux D, Frances C, Barete S, et al. Eosinophilic fasciitis (Shulman disease): new insights into the therapeutic management from a series of 34 patients. Rheumatology. 2012; 51: 557–61.Wright NA, Mazori DR, Patel M, et al. Epidemiology and Treatment of Eosinophilic Fasciitis: An Analysis of 63 Patients From 3 Tertiary Care Centers. JAMA dermatology. 2016; 152: 97–9.Zachariae H, Bjerring P, Halkier-Sorensen L, et al. Skin scoring in systemic sclerosis: a modification–relations to subtypes and the aminoterminal propeptide of type III procollagen (PIIINP). Acta dermato-venereologica. 1994;74: 444–6.Disclosure of InterestNone declared