Renal histology with WHO class IV predicted a poor long-term remission rate. Age, sex, ethnicity, serological parameters and treatment received did not predict long-term remission. Renal flares can occur up to 15 years after a patient has gone into remission.

Objective Despite the widespread clinical use of MTX in PsA, data from published randomized controlled studies suggest limited efficacy. The objective of the present study was to document the efficacy of MTX. Methods This was an open-label, prospective study of patients satisfying the ClASsification criteria for Psoriatic ARthritis study (CASPAR) criteria for PsA who received MTX in doses of ⩾15 mg/week throughout the follow-up period of 9 months. Disease activity was assessed across various domains by tender and swollen joint count, physician and patient global assessment, DAS-28 ESR, Clinical Disease Activity Index for PsA (cDAPSA), Leeds Dactylitis Instrument basic, Leeds Enthesitis Index (LEI), Psoriasis Area and Severity Index (PASI), Minimal Disease Activity and HAQ (CRD Pune version) at baseline and at 3, 6 and 9 months of follow-up. Response to therapy was assessed by EULAR DAS28 ESR, Disease Activity Index for PsA (cDAPSA) response, HAQ response and PASI75. MTX dose escalation and the use of combination DMARDS were dictated by disease activity. Results A total of 73 patients were included, with mean (s.d.) age 44 (9.7) years. The mean (s.d.) dose of MTX used was 17.5 (3.8) mg/week. Seven patients received additional DMARDS (LEF/SSZ). At the end of 9 months, significant improvement (P < 0.05) was noted in the tender joint count, swollen joint count, global activity, DAS-28ESR, cDAPSA, Leeds Dactylitis Index basic, LEI, PASI and HAQ. Major cDAPSA response was achieved in 58.9% of patients. EULAR DAS28 moderate and good response was achieved in 74% and 6.8% of patients, respectively. Minimal Disease Activity was achieved in 63% of patients. A PASI75 response and HAQ response was achieved in 67.9% and 65.8% of patients, respectively. Conclusion MTX initiated at ⩾15 mg/week with targeted escalation resulted in significant improvement in the skin, joint, dactylitis, enthesitis and functional domains of PsA.

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BackgroundIn Takayasu arteritis (TA) Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are used to monitor disease activity. Thirty percent of patients with active inflammation have normal ESR while 40% without vascular inflammation have elevated ESR.1 Pentraxin 3 (PTX3) produced in vascular wall during inflammation, may be a better biomarker of disease activity.ObjectivesTo compare PTX3 levels in TA patients with healthy controls and to compare the accuracy of PTX3 levels with high sensitive CRP (hs CRP) and ESR in distinguishing active from inactive disease.MethodsCross sectional prospective study conducted from 2014 to 2015.Forty consecutive TA patients fulfilling 1990 American College of Rheumatology criteria for TA and 20 healthy controls were included. Disease activity was assessed by Physician Global Assessment (PGA), Indian Takayasu Arteritis Score (ITAS)2 and ITAS-ESR. Serum PTX3 levels (pg/ml) was measured in TA patients and controls, hsCRP (ng/ml)and ESR (mm/hr)were measured in TA patients. Based on PGA patients were divided into active, grumbling and inactive disease.Serum PTX3, hs CRP and ESR were expressed as mean (SD). ROC were constructed for serum PTX3, hs CRP and ESR in differentiating active from inactive disease. p value <0.05 was considered significant. SPSS Software (version 21) was used.ResultsMean age of TA patients and Healthy controls was 27 (7.9), 20 (3.4) years respectively.90% patients were female.Mean disease duration was 3.4 (3.1) years (range 1–12 yrs). Weight loss, fatigue, anorexia were the presenting symptoms followed by claudication. There were 14 patients with active disease, 8 with grumbling disease and 18 with inactive disease.Mean (SD) ITAS in patients with active disease 5.9 (3.5) was significantly higher than in patients with grumbling disease 0.9 (1.2) or inactive disease 0.6 (1). Mean ITAS-ESR in active disease was higher than in grumbling and inactive disease but not different between grumbling and inactive disease.Laboratory markers in TA patients grouped by the PGAActiveGrumblingInactivepESR52 (22.1)45.6 (16.2)34.7 (14)<0.026hsCRP13719 (8409)10583 (9961)6165 (6658)<0.03PTX31431 (1013)1170 (1190.5)357 (244)<0.002Mean PTX3 levels were significantly higher in cases compared to healthy controls (895 (935.6), 317 (215.5)) (p<0.026).ROC parameters of Biomarkers for detecting active TA patientsSE %SP%AUCCIESR (>46 mm/hr)50890.740.563–0.921HsCRP (>17090 ng/ml)57890.790.626–0.953PTX3 (>631 pg/ml)71950.860.720–0.994Sensitivity (SE), specificity (SP) and area under the curve (AUC) with confidence intervals (CI).ConclusionsPTX3 performed better than hs CRP and ESR in differentiating active from inactive disease. Grumbling disease could not be differentiated from inactive disease using ITAS/ITAS-ESR. Inflammatory markers did not perform well in differentiating grumbling disease from active or inactive disease in TA.ReferencesLupi-Herrera E et al Takayasu's arteritis. Clinical study of 107 cases. Am Heart J. 1977; 93:94–103Misra R et al. Development and initial vali...

Available online xxxKeywords: ASAS criteriaChronic low back pain HLA B27 India PCR a b s t r a c t Objectives: To investigate the differences in clinical presentation, disease activity, HLA-B27 positivity in nr-axSpA and AS.Methods: Prospective observational study conducted in tertiary care centre from India. Total 125 consecutive patients with chronic low backache were screened,96 fulfilling ASAS criteria for axial SpA were included and grouped into radiographic (AS) (n ¼ 55) and nonradiographic (n ¼ 41) axial SpA. Demographic, clinical, disease activity and functional indices, ESR were noted from study group. HLA B27 testing was performed in study group by using an in-house PCR method.Results: Patients with AS compared with nr-axSpA were older at presentation (mean 33.7 ± 11.9 vs 26.5 ± 9, p < 0.001), longer mean time to disease diagnosis (4.4 ± 4 vs 1.3 ± 1.7,p < 0.0001) and had higher proportion of positive family history of SpA(29% vs 9.7%,p ¼ 0.02). No statistical significant differences were found in male to female ratio, peripheral arthritis, dactylitis, enthesitis, ESR, HLA B27 positivity, disease activity and functional indices (BASDAI,BAS-G&BASFI)Conclusion: In our study population demography, clinical characteristics and frequency of HLA B27 positivity are similar between nr-axSpA and AS.