Background Prophylactic trimethoprim-sulfamethoxazole (TMP-SMX) prevents pneumocystis jirovecii infection in SLE on immunosuppression. Its role in preventing other major infections in immuno suppressed SLE patients is unknown. Methods A non-concurrent cohort study was conducted on patients of SLE fulfilling SLICC and/or ACR 1997 criteria, who received tapering dose of steroid starting with ≥0.5 mg/kg/day of prednisolone or equivalent dose of deflazacort and mycophenolate mofetil ≥1 g/day (or equivalent dose of mycophenolate sodium) at least for the preceding 1 year. Interviewing patients & documenting relevant data from hospital electronic Medical records (EMR), followed by comparison of Incidence densities of major infections between those on prophylactic Trimethoprim 160 mg + Sulfamethoxazole 800 mg and those not on it, was done by student ‘t’ test. Multivariate logistic regression was performed for independent risk of any major infection between the two groups. Results Of 228 patients, 162 did not receive TMP-SMX prophylaxis, and 66 had received. The incidence density of major infection was found to be significantly lower in TMP-SMX group (1.25 per 100 person year) as compared to those not on TMP-SMX group (11.201 per 100 person year); P < 0.001 (95% CI 0.027 – 0.449) and odds ratio of 0.03 (CI 0 – 0.24). Conclusion Cotrimoxazole prophylaxis in SLE patients on immunosuppression prevents major infections.

Background:Autoimmune uveitis is frequently referred to a rheumatologist for evaluation & treatment. While clinical characteristics of HLA B27 associated uveitis are well documented, scanty information is available on non HLA-B27 associated autoimmune uveitis. We have described the clinical characteristics of our patients of non-B27 uveitis and compare the same with patients of Asian Indian HLAB27 uveitis.Objectives:To describe and compare the clinical characteristics of non HLA-B27 associated autoimmune uveitis.Methods:Retrospective review of records from hospital’s electronic medical record database and included all cases of autoimmune uveitis that were referred to rheumatology from January 2017 and December 2018. Among these, those who did not have HLA B tissue typing record or were HLAB27 positive; were excluded. Pertinent details like age, sex, no. of episodes, unilateral or bilateral, location of uveitis (anterior, posterior or pan uveitis, association of synechiae & vasculitis), baseline CRP & ESR levels along with the HLA B profile(SSP-PCR) & nature of treatment received (systemic steroids, DMARD initiation) were collected. For comparison, clinical features of a HLA B27+ve uveitis series from the same ethnic Asian-Indian population were used1. Subgroup analysis was also done between the common non B27 HLA genotypes. Descriptive statistics were summarized using mean & percentage. Chi square & Fischer’s test was used to compare the groups and subgroups.Results:Out of total 210 patients screened, 17 cases were HLA B27 negative on HLA B tissue typing. The key demographic and clinical features of our patients of autoimmune uveitis not associated with HLA B27 in comparison with the B27 +ve uveitis group are given in table 1.Table 1Comparison of clinical features of our patients versus B27 +ve uveitisNon HLA B27 Autoimmune Uveitis (N=17)Ninan et al (N=25)P valueAge (years) at disease onset 16-35 415 More than 3513 70.009 Onset not known 0 3Sex Male 6210.002 Female11 4Region of uveitis anterior 9240.001 posterior & pan-uveitis 8 1Biochemical parameters CRP (mg/L)6.45 + 8.39N.A- ESR (mm/hr)24.75 + 18.80N.AAssociated complications synechiae formation4 of 174 of 250.69 retinal vasculitis4 of 170 of 17-Recurrent uveitis was seen in 11 out of 17 patients in our patients as compared to 15 out of 22 (p 0.81) in HLA B27 +ve patients.HLA B7 and HLA B35 were the most frequent genotypes (figure 1). Sub group analysis showed that 87.5% of patients with a component of posterior uveitis were HLA B7 or HLA B35 positive. It was noted none of 5 cases of HLA B35 +ve uveitis needed second line DMARD initiation after a tapering course of systemic steroids. There was no other significant difference in the clinical or treatment parameters noted in the subgroup analysis between the HLA genotypes.Conclusion:Autoimmune uveitis not associated with HLA B27 tends to have older age of onset, female predominance, more common involvement of posterior uvea and association of vasculitis than HLAB27 autoimmune uveitis. Among non HLA B27 uveitis, HLA B07 and HLA B35 are the most common serotypes in our Asian south Indian group. Therapeutic stratification for a delayed initiation of second line DMARD therapy needs to be studied further particularly in HLA B35 +ve uveitis.References:[1]Ninan F, Mathew J, Philip SS, John D, Danda D, John SS. Uveitis of spondyloarthritis in Indian subcontinent: a cross sectional study. Int J Adv Med 2017;4:1441-6Disclosure of Interests:None declared

Introduction. There is a scarcity of information available on clinical and laboratory features of adult-onset idiopathic autoimmune uveitis. Therefore, we conducted a single centre descriptive cross-sectional study. Patients and Methods. A chart review of all patients with idiopathic autoimmune uveitis with onset after 18 years of age who were referred to the rheumatology department between January 2017 and December 2018 was performed. Their clinical features, demographic features, and HLA-B genotypes were documented and described. Results. Out of 210 patients referred to rheumatology, 66 were found to have uveitis, and 16 of these had an adult-onset idiopathic autoimmune uveitis. Apart from a slight female preponderance (62.5%), our patients were characterized by a high proportion of panuveitis (4 out of 16, i.e., 25%). There was an increased frequency of occurrence of synechiae (5 out of 16, i.e., 31.3%), retinal vasculitis (4 out of 16, i.e., 25%), optic disc edema (3 out of 16, i.e., 18.8%), and cystoid macular edema (seen in 2 patients, i.e., 12.5%). These features correlated with the anatomical subtypes. Retinal vasculitis and optic disc edema present in three fourth of all panuveitis cases were the most prominent features. The odds of finding HLA-B∗35 in retinal vasculitis were 33 times higher than odds of finding it in idiopathic autoimmune uveitis patients not having retinal vasculitis (OR 33; 95% CI 1.6–698). Conclusion. Idiopathic autoimmune uveitis in our patients is characterized by a high frequency of panuveitis and retinal vasculitis, and complications with a probable association between HLA-B∗35 and retinal vasculitis.