Objective: To highlight potential pitfalls in diagnosis and management of patients with concomitant gout and septic arthritis. Methods: Presentation of two patients with concomitant gout and septic arthritis, the latter caused by Streptococcus agalactiae and Staphylococcus aureus , in one patient each. We also reviewed the English language literature on PubMed for similar cases. Results: Data on concurrent gout and septic arthritis is limited. Three case series of 14, 25, and 30 patients each where identified. The coexistence of septic arthritis and gout is an infrequent condition. Clinical appearance of the two diseases may be very similar and the presence of monosodium urate (MSU) crystals per se cannot exclude infection. On the other hand, patients with chronic tophaceous gout are prone to infection of MSU tophi and the development of biofilms on the latter may render the eradication of microbes particularly difficult. Vice versa, persistent activation of the immune system fuelled by the infection, together with prolonged hospitalisation and immobilisation, may increase the risk for a gout flare, thus initiating a vicious cycle. Conclusion: In patients with gout, a high index of suspicion for infection is needed by treating physicians, because septic arthritis is a medical emergency which can lead to rapid joint destruction.

Background:The current goal of treatment in SLE is remission or low disease activity (LDA) and prevention of flares, achieved with the lowest possible dose of glucocorticoids. Nevertheless, in current clinical practice a significant number of patients still has active disease.1,2Objectives:To assess the current disease activity state of SLE patients during their most recent visit in two centers (Department of Rheumatology in “Asklepieio” Hospital and Rheumatology Unit in “Attikon” Hospital, both in Athens, Greece).Methods:Cross-sectional study of patients with a diagnosis of SLE for at least one year. Patients were divided into four groups: 1) Remission off-therapy: SLE Disease Activity Index (SLEDAI)=0 without prednisone or immunosuppressive drugs (IS), 2) Remission on-therapy: SLEDAI=0, prednisone dose ≤5mg/day and/or IS (conventional and biologic, maintenance phase), 3) LDA: SLEDAI ≤4, prednisone dose ≤7.5mg/day and/or IS (maintenance phase), 4) Active disease: SLEDAI >4 and/or prednisone dose >7.5mg/day and/or IS (induction phase).2 Hydroxychloroquine was allowed in all groups.Results:205 patients were included [95.1% female, mean (SD) age 48.4 (14.9) years and median disease duration (IQR) 6.2 (12.6) years]. A history of lupus nephritis and neuropsychiatric SLE was present in 16.6% and 17.1% of our patients, respectively, and 39% of patients had SLICC/ACR damage index (SDI) > 0. At last visit, remission off-therapy and remission on-therapy was present in 8.3% (n=17) and 15.1% (n=31) of our patients, respectively. Seventy-five patients (36.6%) had LDA, whereas 82 patients (40%) had active disease. More than 85% (86.3%) of patients were in treatment with hydroxychloroquine and 64.4% were receiving immunosuppressive drugs. Regarding glucocorticoids, 50.2% (n=103) were treated with prednisone dose ≤7.5mg/day and over 40% (42.4%, n=87) did not receive prednisone at all. A SLEDAI score 0 and 1-4 was achieved in 24.4% and 42.9% of patients, respectively, but only 3.9% had a SLEDAI > 8, indicative of high disease activity.Conclusion:Although the majority of our patients were treated with hydroxychloroquine and glucocorticoids in acceptable levels of daily dose, four out of ten patients in our practice have active disease during their last visit. Achieving treatment goals in SLE patients remains a challenge for future novel therapies.References:[1]Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 736–745.[2]Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, et al. Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL). Ann Rheum Dis 2017; 76: 2071–2074.Disclosure of Interests:None declared

BackgroundPatients with active rheumatoid arthritis (RA) are at risk for poor functional outcomes, affecting quality of life (QoL). SF-36 is a validated instrument to measure health-related quality of life (HRQoL) in various domains of physical and mental health1, and has been validated in RA. Nevertheless, data on the impact of RA disease activity on SF-36 scores in Greek patients are lacking.ObjectivesTo compare SF-36 scores in Greek RA patients versus the general population and to assess the impact of disease activity on HRQoL.MethodsCross-sectional study in RA patients followed in the Department of Rheumatology, Asklepieio Voulas General Hospital (05-10/2021). Demographic characteristics, state of disease activity and current treatment for RA were recorded at most recent visit. All patients completed SF-36 questionnaires and were classified in three subgroups of DAS28-disease activity: i) Remission or Low disease activity (LDA), ii) Moderate disease activity (MDA), and iii) High disease activity (HDA). Data from the SF-36 validation study in the Greek general population with 1007 participants, were used as historical controls2. Descriptive statistics, one-way ANOVA and linear regression were used for statistical analyses.Results107 patients participated in the study (80,4% females, mean (SD) age 63.3 (12.1) years, 64.5% seropositive, 72% overweight or obese). One third (n=36) were active smokers and 63% (n=67) were receiving a biologic disease modifying antirheumatic drug (bDMARD).Patients with RA exhibited low scores in all SF-36 domains and reported significantly worse results compared to the general population (Figure 1).Figure 1.Physical component score (PCS) and Mental component score (MCS) of the SF-36 showed a negative correlation with DAS28 (β= -8.28, p= <0.001 and β= -6.2, p= <0.001, respectively). Patients with remission or LDA exhibited better SF-36 scores compared to the other subgroups; moreover, patients with MDA had better SF-36 scores than those with HDA (Table 1). When patients with MDA were further divided into low- and high-moderate disease activity (DAS28: 3,21-4,19 and 4,2-5,1, respectively), no significant difference in any SF-36 domain was found between the two groups.Table 1.SF-36 domain mean±SDRDA or LDA 51%MDA 37,2%HAD 11,7%p-valuePF48,43 ±34,2332,14 ±19,8320 ± 19,750.003RP34,9 ±43,6820,71 ± 32,920 ± 00.015BP51,2 ±30,4728,24 ± 24,4918,86 ± 23,54<0.001GH48,83 ±4541,57 ± 24,2532,27 ± 19,540.043VT49,48 ±22,2234,14 ± 18,5730,91 ± 15,940.001SF52,16 ±35,3340,36 ± 27,1328,41 ± 14,890.041RE39,01 ±44,6827,62 ± 40,8118,18 ± 34,520.246MH54,08 ±23,2447,57 ± 21,7540 ± 18,590.124ConclusionHRQoL assessed by SF-36 is dampened in RA patients, in both physical and mental component. Disease activity had a negative impact on both physical and mental components of HRQoL. Patients with remission or LDA showed better HRQoL outcomes, suggesting that the treat-to-target approach may also positively affect QoL.References[1]Ware, J. E., Jr, & Gandek, B. (1998) Journal of clinical epidemiology, 51(11), 903–912.[2]Pappa E et al. Qual Life Res. 2005 Jun;14(5):1433-8Disclosure of InterestsNone declared