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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.

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...

BackgroundDiffuse Alveolar hemorrhage (DAH) a rare life threatening manifestation of Systemic Lupus Erythematosus (SLE) with high mortality.1,2ObjectivesTo characterize the profile of SLE patients with DAH in our cohort.MethodsMedical charts of patients with SLE and DAH from 2008 to 2015 in our institute were reviewed. Clinical, laboratory, treatment, outcome details were noted. Statistical analysis carried out with SPSS software (version 21). Independent sample T test was done to compare survivors and non-survivors.ResultsNineteen (1.32%) of 1438 SLE patients had DAH. Their mean age was 24.2±7.8 years, mean duration of hospital stay 16.1±7.5 days, mean SLE disease activity index (SLEDAI) (19.2 ±8.7). Seven had DAH at initial diagnosis of lupus, 4 had recurrent episodes of DAH. Ten (52.6%) patients died. Clinical manifestations included fever (84.2%), cough (78.9%), dyspnea (100%), hemoptysis (73.7%). Organ involvement include nephritis in (14/19) 73.7%, CNS involvement (6/19) 31.6%, arthritis (9/19) 47.4%, mucocutaneous (13/19) 68.4%, myocarditis (5/19) 26.3%, pulmonary arterial hypertension (7/19) 36.8%, serositis (8/19) 42.1%, renal failure (8/19) 42.1%, autoimmune hemolytic anemia in (2/19) 10.5% patients. Leucopenia (10/19) 52.6%, thrombocytopenia (11/19) 57.9%, low complements in 14/15 patients, dsDNA positive in (16/19) 84.2%, aCL antibody positivity in 4/14, raised serum procalcitonin in 3/14. Mean erythrocyte sedimentation rate (ESR) was 52.9±41.6 mm first hour, mean creatinine 1.6±1.5 mg/dl. Concomitant infection was seen in 7 (36.8%) patients. Respiratory tract infection was seen in 5 (4 had bacterial, 1 had strongyloides) and 2 had systemic infection. Eleven (57.9%) required mechanical ventilation. All patients received intravenous methylprednisolone pulses, cyclophosphamide in (16/19) 84.2%, IVIg in 2, Rituximab in 1, plasmapheresis in 1 patient. Median follow up of survivors is 33 months, 2 lost to follow up.Univariate analysis showed age and high ESR as independent risk factors associated with DAH. Mortality was associated with requirement of mechanical ventilation.ConclusionsDAH in SLE is rare, but associated with high mortality. It occurs in patients with high disease activity. Requirement of mechanical ventilation is associated with higher mortality.ReferencesMartínez-Martínez MU, Abud-Mendoza C. Predictors of mortality in diffuse alveolar haemorrhage associated with systemic lupus erythematosus. Lupus.2011;20:568–74.Zamora MR, Warner ML, Tuder R, Schwarz MI. Diffuse alveolar hemorrhage and systemic lupus erythematosus: clinical presentation, histology, survival, and outcome. Medicine 1997; 76: 192–202.Disclosure of InterestNone declared