The objective of this study was to evaluate human papillomavirus (HPV) and Chlamydia trachomatis (CT) infections in RA patients pre- and post-TNF blocker. Fifty female RA patients (ACR criteria), who were eligible to anti-TNF therapy [n = 50 at baseline (BL) and n = 45 after 6 months of treatment (6 M)], and 50 age-matched healthy controls were prospectively enrolled. They were assessed for demographic data, gynecologic, sexual, cervical cytology and histological evaluations, disease parameters and current treatment. HPV DNA and CT DNA testing in cervical specimens were done using Hybrid Capture II assays. At BL, the median current age of RA patients and controls was 49 (18-74) versus 49 (18-74) years, p = 1.0. A trend of lower frequency of HPV infection was observed in AR patients pre-anti-TNF compared with controls (14 vs. 30%, p = 0.054). Further evaluation of AR patients with and without HPV infection before anti-TNF therapy showed that the former group had higher frequency of sexual intercourses (100 vs. 48%, p = 0.014), higher median number of sexual partners [1 (1-1) vs. 0 (0-1), p = 0.032] and higher frequency of abnormal cervical cytology (43 vs. 7%, p = 0.029). Current age, disease duration, disease parameters and treatments were alike in both groups (p > 0.05). At 6 M after TNF blockage, HPV infection remained unchanged in five patients, whereas two became negative and one additional patient turned out to be positive (p = 1.0). CT infection was uniformly negative in RA patients pre- and post-TNF blockage and in controls. Anti-TNF does not seem to increase short-term risk of exacerbation and/or progression of HPV and CT infections in RA patients.

Objective: To determine the clinical and demographic factors associated with disease remission and drug survival in patients with ankylosing spondylitis (AS) on TNF inhibitors. Methods: Data from a longitudinal electronic database of AS patients under anti-TNF therapy between June/2004 and August/2013. Demographic, clinical parameters, disease activity by ASDAS remission (< 1.3) and inactive/low (< 2.1) were analyzed to characterize reasons for drug survival and switching of anti-TNF. Results: Among 117 AS patients, 69 (59%) were prescribed only one anti-TNF, 48 (41%) switched to a second anti-TNF and 13 (11%) to a third anti-TNF. Considering ASDAS-CRP < 1.3, 31 (39%) patients were inactive at the end of the study. Non-switchers (P = 0.04), younger age (P = 0.004), non-smoking (P = 0.016), shorter disease duration (P = 0.047), more frequent use of SSZ (P = 0.037) and lower BASDAI (P = 0.027), BASMI (P = 0.034) and BASFI (P = 0.003) at baseline were associated with remission. In the multivariate analysis younger age (P = 0.016) and lower BASDAI (P = 0.032) remained as remission predictors. Conclusion: This study supports that ASDAS-CRP remission is an achievable goal not only for non-switchers but also for second anti-TNF, particularly in patients with younger age and lower BASDAI at baseline. Comedication and non-smoker status seems to have a beneficial effect in anti-TNF response in this population.

BackgroundHip involvement is considered an important prognostic factor associated with radiographic progression in ankylosing spondylitis (AS) patients. However, there are no studies regarding hip involvement impact on clinical response and radiographic progression in AS patients under anti-TNF therapy.ObjectivesCompare clinical and radiographic progression in AS patients receiving anti-TNF therapy with and without moderate-severe hip involvement.MethodsForty-seven AS patients referred to receive anti-TNF treatment were included and classified according to baseline hip involvement based on Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-Hip): none-minimal hip disease (hip grade <3) or moderate-severe disease (hip grade ≥3). Demographic data, presence of HLA-B27, extra-articular involvement, DMARD and NSAID use, clinical and laboratorial disease parameters (BASDAI, BASMI, BASFI, ASQol, mSASSS and inflammatory markers) were assessed at baseline and two years after anti-TNF treatment.ResultsThirty-four (72.3%) patients were classified as none-minimal hip disease and 13 (27.7%) as moderate-severe hip involvement. Both groups were similar at baseline considering age, HLA-B27, extra-articular involvement and comedication use. Laboratorial markers (ESR, CRP) and disease parameters (BASDAI, BASFI and mSASSS) showed no difference at baseline. Moderate-severe group had longer disease (10.0±7.6 vs. 14.9±8.6, P=0.002, years), higher BASMI (3.8±2.4 vs. 6.5±2.5, P=0.002) and lower ASQoL (13.7±4.4 vs. 9.9±4.9, P=0.007). After two-years of anti-TNF therapy, both groups presented similar BASDAI response (delta BASDAI, p=0.134; final BASDAI, p=0.324) and an increase in mSASSS [no-minimal involvement: 13.6±18.3 vs. 16.1±19.4, P<0.001); moderate-severe involvement: 21.7±19.9 vs. 28.6±18.5, P=0.003]. At final evaluation patients with moderate-severe hip involvement presented higher mSASSS (28.6±18.5 vs. 16.1±19.4, P=0.02), despite similar delta BASDAI and final BASDAI.ConclusionsOur study provides evidence that hip involvement did not impact on clinical response in AS patients under anti-TNF therapy but may have an effect on radiographic progression of these patients.Disclosure of InterestNone declared

Dedico em verso e poesia Sorriso largo Olhos marejados Coração aberto Transbordando alegria Respiro fundo E dedico ... Aos meus pais Essência do meu eu Motivo da minha existência À minha irmã Primeira parceira da vida Com quem aprendi a dividir Ao meu marido À vida traz paixão Força e calmaria Leveza aos meus pés no chão Aos meus dois filhos Reflexos da minha alma A vocês seis todo meu amor AGRADECIMENTOS Às pacientes pela confiança e colaboração essências para realização deste trabalho. Ao meu orientador Prof. Dr. Clóvis Artur Almeida da Silva pela paciência infinita e pela capacidade de despertar em mim a coragem para enfrentar este desafio.

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