Tuberculosis (TB) is a major concern in patients receiving TNF inhibitors (TNFi). This study aimed to assess the incidence of active TB and the efficacy of TB prevention measures used over the years, and to determine risk factors for developing TB, in a single-centre cohort of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) receiving TNFi. Data of all patients in whom treatment with TNFi was initiated in our rheumatology clinic until December 1st 2014 have been retrospectively analysed. The cohort was divided into 3 groups per the mandatory LTBI screening method at baseline: tuberculin skin test (TST) with a positive threshold of either 10 mm (group TST1), or 5 mm (group TST2), and QuantiFERON®-TB Gold test (group QFT). The incidence of active TB was analysed for each group and compared to TB incidence data in general population. Five hundred fifty patients were included (305 RA, 42 PsA, 203 AS); 97 patients belonged to the TST1, 229 to the TST2 and 224 to the QFT group. The number of active TB cases/time of exposure to TNFi (person-years, PY) was 8/593.5, 9/1044.0 and 3/555.3, respectively, accounting for an incidence of 1348.0, 862.1 and 540.2 cases per 10 PY. Active TB cases occurring in the first year of TNFi treatment (early TB) per total TB cases were only 3/8, 1/9 and 1/3, respectively, too few to identify statistically significant differences between the 3 LTBI screening protocols. However, less TB cases per total observation time were registered in the QFT group, probably due to the reduced duration of exposure to TNFi. All cases of active TB were registered among patients receiving monoclonal antibodies TNFi agents. We have found no significant risk factors for developing active TB. In our cohort, TB occurring after 1 year of TNFi treatment exceeds 'early TB', suggesting the necessity of further TB prevention measures besides baseline screening for LTBI.

Systemic sclerosis (SSc) is a chronic autoimmune disease causing complex hand disability. A reliable tool for hand function assessment in SSc is the Cochin Hand Functional Disability Scale (CHFS). More recently, a short-form CHFS of 6 items (CHFS-6) has been developed. Objectives To validate the CHFS and the new CHFS-6 in Romanian patients with SSc. Patients and Methods Consecutive patients with SSc who completed the CHFS were included. All patients were assessed according to the recommendations of the European Scleroderma and Research Trials and also completed the Scleroderma Health Assessment Questionnaire and the Hand Mobility in Scleroderma questionnaire. Finger range-of-motion distances were measured. Results Seventy patients, 63 female and 7 male patients (age median, 53.0 years; interquartile range [IQR], 21.0 years), were included. Twenty seven had diffuse cutaneous involvement (dcSSc). Median CHFS and CHFS-6 at baseline were 25.0 (IQR, 37.0) and 8.0 (IQR, 13.0), respectively. The internal consistency (Cronbach α = 0.96, respectively, 0.90, in all 70 patients) and test-retest reliability (intraclass correlation coefficient = 0.98 for both, in 38 patients) of both CHFS and CHFS-6 were excellent. The CHFS-6 had a very high correlation with the CHFS. There were moderate to good correlations with Hand Mobility in Scleroderma, Scleroderma Health Assessment Questionnaire, and the anthropometric measurements (construct validity). In patients with early dcSSc with a second evaluation, we found good to moderate sensitivity to change (standardized response mean of 0.8 and effect size of 0.4 for CHFS, and standardized response mean of 1.1 and effect size of 0.6 for CHFS-6). Conclusions The CHFS and CHFS-6 are valid and easy-to-use tools for hand involvement in SSc, which can be used in clinical or research setting.

Capillary density on nailfold capillaroscopy (NFC) is considered a promising instrument for assessing disease characteristics in patients with systemic sclerosis (SSc), however, there is no agreement yet over how to analyze and interpret the results. The objective of this study was to investigate the possible associations of the mean number of capillaries with disease characteristics, disease activity [measured by the European Scleroderma Study Group (EScSG) disease activity score] and survival in a single-center cohort of patients with SSc. Sixty-eight patients were included; 54 had follow-up at 6 months. Thirty-two images per patient were assessed independently by two raters, scoring the mean number of capillaries in all fingers (N), in the 3rd finger of the dominant hand (dN 3) and in the 4th finger of the non-dominant hand (ndN 4) for each patient. NFC 'early', 'active' and 'late' patterns were also assessed. Two thousand and seventy-six images were scored at baseline, 1,728 at follow-up. Baseline N was median (IQR) 5.1 (2.7) for rater 1, and 4.9 (1.7) for rater 2, respectively. N was significantly lower in patients with a history of digital ulcers (DUs), vs. those who never had DUs 4.8 (1.4) vs. 6.4 (3.1), P=0.016. A lower N was associated with higher disease activity at baseline and follow-up (linear regression adjusted for age, sex and history of DUs). A lower ndN 4 was associated with increased mortality (logistic regression adjusted for age and sex). In conclusion, in patients with SSc, a lower mean number of capillaries assessed by NFC was associated with higher disease activity after 6 months of follow-up and with shorter survival.

BackgroundSystemic sclerosis (SSc) is a connective tissue disease characterized by skin and internal organs fibrosis, microvascular impairment and frequently by disability and early retirement.ObjectivesTo assess employment status, risk factors for early retirement (ER) and the associations of ER with disease characteristics and with patients' health-related questionnaires (Scleroderma Health Assessment Questionnaire (SHAQ)) and hand function (Duruoz hand index (DHI)).MethodsThis study included patients with SSc according to the 2013 ACR/EULAR classification criteria, examined in our EUSTAR center from 11.2011 to 11.2016, who were under the legal age of retirement of in our country (62 years). Patients completed a work assessment questionnaire, the DHI and the SHAQ, as well as a full assessment as per the recommendations of EUSTAR.Logistic regression was used to investigate the associations between employment status (outcome) and potential predictors (including socio-economic status, education, disease characteristics and health-related questionnaires).ResultsThere were 66 patients (8 males, mean±SD age 49.1±9.3 years, 19 with diffuse cutaneous SSc (dcSSc), 46 with history of digital ulcers (DUs) and 23 with joint contractures) included. Forty-two patients lived in urban environments and 42 had higher education (high school or above).Twenty patients were active professionally, whereas 46 were retired, of which 32 retired because of SSc. Of those active professionally, 8 had to do manual labor, 7 had to spend many hours at work standing and 3 had a cold or moist work environment.Using logistic regression adjusted for age and gender, higher education was found to be highly associated with employment (OR (95% CI) 9.0 (1.5, 52.4)), whereas labor conditions (manual labor, stress) had no significant influence on employment status in our cohort. No association was found between employment status and disease characteristics or SHAQ and DHI questionnaires.ConclusionsSSc is associated with substantial work disability and unemployment. Completing less education than high school was associated with early retirement.Acknowledgements*This abstract was realized as part of the “Development of a computer-based nailfold videocapillaroscopy (NVC) system for longitudinal evaluation of patients with systemic sclerosis” (QUANTICAP) project, financed by the UEFIS-CDI PN-II-PT-PCCA-2013–4-1589 grant. Disclosure of InterestNone declared

BackgroundTuberculosis (TB) is a major concern in patients receiving TNF inhibitors (TNFi).ObjectivesTo assess the incidence of active TB and the efficacy of TB prevention measures in a large, single-center cohort of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) receiving TNFi.MethodsData of all patients in whom treatment with TNFi was initiated in our rheumatology clinic from January 1st 2002 until December 31st 2015 have been retrospectively analysed. The cohort was divided into 2 groups per the mandatory latent TB infection (LTBI) screening method at baseline: tuberculin skin test (group TST), and QuantiFERON®-TB Gold test (group QFT). The incidence of active TB was analysed for each group and compared to TB incidence data in general population.Results653 patients were included (344 RA, 52 PsA, 257 AS); 324 patients belonged to the TST and 329 to the QFT group. The number of active TB cases/ time of exposure to TNFi (person-years, PY) was 17/2002.6 and 7/1041.2 respectively, accounting for an incidence of 848.9 and 672.3 cases per 105 PY, about 8 times higher (8.3 and 8.8 for TST, respectively QFT group) than the average TB during the period of exposure to TNFi. LTBI reactivations per total TB cases were only 4/17 and 2/7, respectively, too few to identify statistically significant differences between the 2 LTBI screening protocols. Only 10 patients had pulmonary TB, whereas the rest were disseminated TB (8 cases), TB pleurisy and/or pericarditis (4 cases), one mediastinal lymph node TB and one isolated hepatic TB. Using Pearson chi-square test, we found no significant differences between LTBI group and active TB (Table 1).Table 1.LTBI screening results and TB occurrence in the 653 TNFi-treated patients (Pearson χ2 test)TSTQFTAllp value (n=324)(n=329)(n=653) Positive immuno-diagnostic test at baseline52 (16.0%)63 (19.1%)115 (17.6%)<0.001*Active TB17 (5.2%)7 (2.1%)24 (3.7%)0.185*Reactivation TB4 (1.2%)2 (0.6%)6 (0.9%)**New infection TB13 (4.0%)5 (1.5%)18 (2.8%)0.052*Total TB incidence (per 105 PY)848.9672.3788.5–Maximal period of TNFi exposure in group2002–20162011–20162002–2016–Mean TB incidence in Romania in the respective time period (per 105 PY)102.376.7102.3–TB incidence patients/general population8.38.87.70.88†*Pearson χ2test comparing TST and QFT. **Reactivation TB cases were too few to perform statistical testing. †Pearson χ2test comparing total TB incidence in the TST and QFT groups to the average TB incidence in our region in the respective period of exposure.ConclusionsIn our cohort, new infection TB exceeds reactivation TB, suggesting the necessity of periodical LTBI re-screening.Disclosure of InterestA. M. Gheorghiu: None declared, A. Garaiman: None declared, A. Radu: None declared, A. Soare: None declared, V. Aramă: None declared, D. Bumbăcea: None declared, R. Dobrotă: None declared, R. Oneata: None declared, S. Pintilie: None declared, M. Milicescu Speakers bureau: Has received sponsoring from Abbvie, MSD and Pfizer., I. Ancuta Grant/research...