BackgroundThere is an increasing need for alternative, non-invasive and reliable diagnostic tools with the potential to improve and simplify the diagnostic process for primary Sjogren’s syndrome (pSS). The main advantage of salivary gland ultrasonography (SGUS) is the direct visualisation of structural abnormalities of the salivary glands. Despite these advantages of SGUS, a number of obstacles remain. Different SGUS scoring systems in B-mode were used in previous studies. The diagnostic usefulness of Doppler analysis and glandular size measurement has not been established. Indeed there is no proven prognostic factor for glandular damage in pSS, although a number of studies have revealed the risk factors for lymphoma.ObjectivesWe aimed to assess the diagnostic value of SGUS as a single test for the detection of pSS in an integrated manner. We assessed the diagnostic accuracy of three SGUS parameters: the ultrasound (US) grey-scale scoring system, glandular volume measurement, and intraglandular power Doppler US. The secondary aim was to examine the prognostic factors for severe structural changes in major salivary glands based on the SGUS scoring system.MethodsPatients with pSS (n=94) and idiopathic sicca syndrome (n=44) were evaluated using the SGUS 0–48 scoring system, which comprises five parameters: parenchymal echogenicity, homogeneity, hypoechoic areas, hyperechogenic reflections, and clearness of posterior borders (figure 1). The salivary gland volume and intraglandular power Doppler signal (PDS) were also assessed. A multivariate linear regression analysis was performed to determine the factors associated with SGUS score.ResultsPatients with pSS showed a significantly higher SGUS score than controls [median (IQR): 24.5 (13.0) vs 6 (3.75), p<0.001]. An SGUS cut-off of ≥14 had a sensitivity of 80.9% and a specificity of 95.5% for the diagnosis of pSS. There were no significant differences in the measured volumes and PDS between pSS patients and controls. The SGUS score correlated with unstimulated salivary flow rate (USFR), serum rheumatoid factor and IgG. Double seropositivity with anti-Ro/SS-A and anti-La/SS-B (β=6.060, p=0.001) and USFR (β=−1.913, p<0.001) were independently associated with the SGUS score.ConclusionsThe SGUS scoring system is a valuable diagnostic method for pSS. Double seropositivity of anti-Ro/SS-A and La/SS-B is an independent predictive factor for structural damage of the salivary glands.References[1] Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, et al. 2016American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjogren’s syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis2017;76:9–16.[2] Jousse-Joulin S, Milic V, Jonsson MV, Plagou A, Theander E, Luciano N, et al. Is salivary gland ultrasonography a useful tool in Sjogren’s syndrome? A systematic review. Rheumatology (Oxford)2016;55:789–800.AcknowledgementsThis paper was supported by Konkuk University...

Recently the regional impact assessment due to global warming is one of the urgent tasks to every country in the world, under the circumstances of increasing carbon dioxide in the atmosphere. This assessment must include not only meteorological factors, such as surface air temperature and precipitation, etc., but also the response of the local ecosystem. Based on a previous study, for example, it has been known that Phyllostachys' habitation, which is one of the bamboo species popular in Korea, is quite sensitive to temperature change, in particular during the winter season. Thus, adequate climate information is essential to derive a solid conclusion on the regional impact assessment for future climate change.In this study, we adopted a dynamical downscaling technique to get regional future climate information, with the regional climate model (MM5, Pennsylvania State University/National Center for Atmospheric Research mesoscale model) from the Max-Planck Institute for Meteorology Models and Data Group's Atmosphere-Ocean General Circulation Model (AOGCM) ECAHM4, and HOPE-G (ECHO-G) simulation for future climate, based on future greenhouse gas (GHG) emission scenario of the Intergovernmental Panel on Climate Change (IPCC) Special Report on Emission Scenarios (SRES) A2. Through this nesting process we got reasonable regional climate change information. However, we found a couple of systematic differences, such as a cold bias in the surface air temperature, simulated by MM5 compared to that by the AOGCM ECHO-G. This cold bias may cause to loose credibility on the future climate scenario to the impact assessment studies. Accordingly, we introduced a transfer function to correct the systematic bias of the dynamic model in the regional-scale, and to predict the regional cliCorresponding author: Jai-Ho Oh, Integrated Climate System Modeling Group, Department of Environmental Atmospheric Sciences, Pukyong National University, 599-1 Daeyeon3-dong, Namgu, Busan 608-737, South Korea. E-mail: jhoh@pknu.ac.kr ( 2004, Meteorological Society of Japan mate from large-scale predictors. These transfer functions are obtained from the daily mean temperature of 17 surface observation stations in Korea for 10 years from 1992 to 2001, and 10-year simulation data obtained from regional climate model (RCM) for each mode of EOFA to correct the systematic bias of RCM data.With these transfer functions, we can correct the RMS error of the daily mean temperature in RCM as much as 47.6% in winter and 86.5% in summer. After dynamical downscaling and statistical adjustment, we may provide adequate climate change information for regional assessment studies.

Objective: To assess the diagnostic performance of ultrasound (US) for calcium pyrophosphate deposition (CPPD) at the level of menisci, hyaline cartilage (HC), tendons, and synovial fluid (SF) of the knee, and to examine inter-and intra-observer reliability. Design: We consecutively included patients with knee effusion over a 2-year period (43 patients with CPPD and 131 controls). All patients underwent SF analysis, conventional radiography (CR), and US examination using the Outcome Measures in Rheumatology (OMERACT) definition of the US characteristics of CPPD. Two independent operators performed the US, and inter-observer agreement was calculated. Intra-observer agreement was examined with static images obtained for all enrolled patients. Results: US revealed calcium pyrophosphate (CPP) deposits in menisci, HC, and tendon more frequently in patients with CPPD than in control patients. The presence of US CPP deposits in SF was not significantly different between the two groups. Combined US evaluation of the three components (menisci, HC, and tendon) showed the best diagnostic performance. The sensitivity and specificity for US evaluation of the three components were 74.4% and 77.1%, respectively, while for CR evaluation, the sensitivity and specificity were 44.2% and 96.9%, respectively. Inter-and intra-observer agreement were excellent for medial (k ¼ 0.930, 0.972) and lateral menisci (k ¼ 0.905, 0.942), HC (k ¼ 0.844, 0.957), and SF (k ¼ 0.817, 0.925). Tendon showed fair inter-observer (k ¼ 0.532) and good intra-observer reliability (k ¼ 0.788). Conclusions: Based on the OMERACT definition, US demonstrated better diagnostic capacity than CR to diagnose CPPD, with excellent reliability. Combined evaluation of menisci, HC, and tendon showed the best diagnostic accuracy.

Background Vascular endothelial growth factor (VEGF) is an angiogenic, inflammatory, and bony destructive molecule in the pathogenesis of rheumatoid arthritis (RA). Objectives This study was aimed to determine the specific role of VEGF on the osteoclastogenesis in RA. Methods The expression of VEGF, CD55, and receptor activator of nuclear factor kB ligand (RANKL) in RA synovial tissues was analyzed using confocal microscopy. VEGF-induced RANKL expression was determined in RA synovial fibroblasts using reverse transcription PCR, luciferase assays and ELISA. Osteoclastogenesis was assessed by counting tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells from the culture of isolated CD14+ monocytes with VEGF in the presence of signal inhibitors. Osteoclastogenesis was also determined after co-culture of monocytes with VEGF–pretreated synovial fibroblasts and CD4+ T cells. Results There was co-expression of VEGF, RANKL and CD55 in lining and sublining area of RA synovium. The RANKL level correlated with the VEGF level in synovial fluid from RA patients. VEGF stimulated the expression of RANKL mRNA in RA synovial fibroblasts and RANKL promoter activity was upregulated by VEGF in the synovial fibroblasts transfected with RANKL reporter plasmids. VEGF-induced RANKL expression was decreased by the inhibition of Src and PKC. VEGF induced osteoclast differentiation from peripheral blood monocytes in the absence of RANKL. When monocytes were co-cultured with VEGF-prestimulated RA synovial fibroblasts, monocytes were differentiated into osteoclasts and the osteoclastogenesis decreased with inhibition of Src and PKC signaling. Conclusions VEGF plays dual roles on osteoclastogenesis in RA: induction of osteoclastogenesis from the precursors and direct stimulation of RANKL production in synovial fibroblasts, mediated by Src and PKC pathways. The axis of VEGF and RANKL could be a potential therapeutic target for RA-associated bone destruction. References Lee SS, Joo YS, Kim WU, Min DJ, Min JK, Park SH, et al. Vascular endothelial growth factor levels in the serum and synovial fluid of patients with rheumatoid arthritis. Clinical and experimental rheumatology. 2001;19(3):321-4. Harada M, Mitsuyama K, Yoshida H, Sakisaka S, Taniguchi E, Kawaguchi T, et al. Vascular endothelial growth factor in patients with rheumatoid arthritis. Scandinavian journal of rheumatology. 1998;27(5):377-80. Koch AE. Review: angiogenesis: implications for rheumatoid arthritis. Arthritis and rheumatism. 1998;41(6):951-62. Acknowledgements This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology (NRF-2011-R1A4A007-0026961) Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1254

BackgroundLoss to follow-up can occur with many reasons, which influenced the outcomes of longitudinal cohort studies.ObjectivesTo compare the characteristics of patients who lost to follow-up and patients who completed the 2 years of follow-up, and examine the associated factors for early loss to follow-up (ELTF).MethodsThe study subjects consisted of the KORONA cohort which is a multicenter longitudinal RA cohort. After excluding 1,119 patients who did not complete the 2 years of follow-up but still are actively participating, we divided the patients (n=4,257) into two groups; patients who lost to follow-up within 2 years (ELTF group), and patients who completed the 2 years of follow-up (FU group). Multivariate analysis was performed using the variables significant in univariate analyses and institutional factor. Institutions were divided in 3 groups based on the number of patients enrolled; A (largest) and C (smallest).ResultsELTF group patients (n=1,674, 39%) were older (p=0.04) and less educated (p<0.01). In a multivariate analysis, higher disease activity (OR 1.09, CI 1.02-1.16) and cardiovascular disease (CVD, OR 1.66, CI 1.17-2.34) at enrollment were risk factors for ELTF, whereas longer disease duration (OR 0.98, CI 0.97-0.99) and MTX use (OR 0.59, CI 0.49-0.70) were protective. Patients recruited from institutions of smaller numbers are likely to ELTF (C: OR. 7.65, CI 5.43-10.79, B: OR 3.27, CI 2.73-3.92, for A).ConclusionsRA Patient who have higher disease activity and CVD at enrollment are likely to ELTF, while longer disease duration and MTX use were protective. In addition, institutional factor should be considered as one of main factors for ELTF.ReferencesIannaccone CK, Fossel A, Tsao H, Cui J, Weinblatt M, Shadick N. Factors associated with attrition in a longitudinal rheumatoid arthritis registry. Arthritis Care Res (Hoboken). 2013;65(7):1183-9.Disclosure of InterestNone declared