Serum IL-6 levels from 12 to 24 weeks after TCZ initiation better reflect the efficacy of TCZ at 52 weeks.

patients in both groups were recorded and results were compared both within and between the groups. Results Significant improvements were observed in both groups in morning stiffness, joint pain, Ritchie articular index, serum CRP and ESR levels compared to values before treatment, beginning from first month to sixth month (p < 0.001). In the functional assessment; significant improvements were observed in both, determined beginning from the first month to sixth month compared to before treatment both in group receiving a night dose prednisolone and morning dose prednisolone (p < 0.05). In comparison of morning stiffness, joint pain, Ritchie articular index and its functional assessment, and serum CRP and ESR levels in both groups, no significant difference was obtained from first month to sixth month (p > 0.05). Conclusion Low dose prednisolone therapy in treatment of RA significantly suppresses the activity of disease beginning from the first month. This condition is kept until the sixth month. However, administration of the medication either given at morning hours classically or at night according to the diurnal rhythym of disease activity doesn?t affect the results of the treatment.

BackgroundFemales compared with males display greater sensitivity in response to noxious stimulation and especially the pressure pain and electrical stimulation are largest1). In rheumatoid arthritis (RA), females compared with males score significantly higher on ESR, patient's global assessment, tender joint count (TJC), HAQ, DAS28ESR, and DAS28CRP just before initiation of first biologics therapy2). Barnabe3) supports that treatment with disease-modifying therapy results improvement in mean pain scores for both sexes: however, female absolute scores remain higher in RA. But there is no article on a correlation between the TJC and the swollen joint count (SJC) in terms of sex in RA.ObjectivesTo investigate sex differences in the gaps between the TJC and the SJC in patients with RA.MethodsWe detected the data of the patients who had more than 6 swollen joints and less than 10 years disease duration just before initiation of first biologics therapy. The TJC and the SJC were evaluated using 28 joints. We determined the gaps between the TJC and the SJC (TJSJ gap) using the following equation: TJSJ gap = TJC- SJC. Demographic data and disease activity parameters were collected at base line, 3 and 6 months after biologics treatment started. The differences between females and males were compared using a t-test and a Fisher's exact tests.ResultsA total of 115 patients, of whom 25 were males and 90 females, were detected. Of these patients, 49 received infliximab treatment, 49 eternercept treatment, 8 adalimumab treatment, 5 tocilizumab treatment and 4 abatacept treatment and there are no sex differences in the sort of biologics treatment. At base line, there are no sex differences in age, disease duration, SJC, evaluator's global assessment, patient's global assessment, ESR, DAS28ESR, DAS28CRP, CDAI, SDAI, and concomitant prednisolone and methotrexate. But TJC and TJSJ gap were higher, and CRP was lower in females. There were no sex differences of all variable except higher TJSJ gap at 3 months and higher TJC at 6 months in females. The mean TJC for males and females, were 7.5, 10.7 at base line, and 3.0, 4.2 at 3 months, and 1.5, 3.8 at 6 months, respectively. The mean SJC for males and females, were 9.5, 9.2 at base line, and 4.0, 3.1 at 3 months, and 2.3, 2.7 at 6 months, respectively. The mean TJSJ gap for males and females, were -2.00, 1.53 at base line, and -1.05, 1.09 at 3 months, and -0.86, 1.05 at 6 months, respectively.ConclusionsDespite a similar disease activity, females compared with males had more tender joints than swollen joints, just before initiation of first biologics therapy in patients with RA. Sex differences in gaps between the tender joint count and the swollen joint count decreased over time after biologics therapy started.ReferencesJoseph L. Riley 3rd, et al.: Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 1998, 74(2-3): 181-187Nienke Lesuis, et al.: Gender and the treatment of immune-mediated chronic inflammatory diseases: rheumatoid arthritis, inflamm...

BackgroundThe radiographic joint damage in patients with rheumatoid arthritis (RA) is commonly evaluated by modified total Sharp score (mTSS), however only small joints are assessed in this method. For the evaluation of large joints, we developed and validated a new radiographic scoring method (Assessment of Rheumatoid Arthritis by Scoring of Large Joint Destruction and Healing in Radiographic Imaging: ARASHI)1).ObjectivesThe purpose of this study is to evaluate the correlation of small joint damage and large joint damage using the the mTSS and the ARASHI scoring system in RA.Methods“ARASHI status score” consists of 4 categories; joint space narrowing, erosion, joint surface destruction, and stability (total 0–16 points). “ARASHI change score” consists of 5 categories; porosis, joint space narrowing, erosion, joint surface destruction, and stability (total -11–12 points). Forty two patients (3 male, 39 women, mean age of 64.0 years old, mean disease duration of 12.3 years) who started treatment with abatacept were enrolled in this study. All patients fulfilled the ACR 1987 revised criteria. The joints with history of surgical intervention were excluded from this analysis, and the radiographic findings of 390 large joints (81 shoulders, 80 elbows, 79 hips, 69 knees and 81 ankle joints) were evaluated at baseline using the ARASHI status score, and assessed by the ARASHI change score at 1 year of abatacept therapy. We also evaluated mTSS of all patients at baseline and at 1 year of therapy, and the yearly change (ΔmTSS) was estimated. Correlation between mTSS and ARASHI score was evaluated by Sperman's rank correlation coefficient.ResultsThe mean values of mTSS and ARASHI status score at baseline were 105.9 (range: 0–417) and 1.002 (range: 0–12), respectively. At 1 year of abatacept therapy, the mean value of ΔmTSS was 0.9154 (range: -1–6) and the mean value of ARASHI change score was 0.1936 (range: -3–5). There was significant correlation between mTSS and ARASHI status score at baseline (r=0.4592, P<0.0001). On the other hand, there was no significant relationship between ΔmTSS and ARASHI change score (r=-0.0369, P=0.4750).ConclusionsWe demonstrated a significant correlation between mTSS and ARASHI status score at baseline. This finding supports a general understanding that damage in small and large joints is correlated although the damage of large joints may have a later onset. In this study, however, there was no relationship between ΔmTSS and ARASHI change score at 1 year. It is possible that damage progression in small and large joints may not be highly correlated. Therefore, monitoring of both of small and large joint damage should be necessary to guide treatment for patients with RA.ReferencesAtsushi Kaneko, Isao Matsushita, Katsuaki Kanbe, Katsumitsu Arai, Yoshiaki Kuga, Asami Abe, Takeshi Matsumoto, Natsuko Nakagawa, Keiichiro Nishida. Development and validation of a new radiographic scoring system to evaluate bone and cartilage destruction and healing of large joints with rheumatoid arthritis: ARASHI (Asses...

BackgroundSome skeletal muscles communicate with other organ by secreting proteins and peptides called myokine. Some myokines have anti-inflammatory effect1). As regards rheumatoid arthritis (RA), many studies have shown that aerobic and resistance exercise programs do not change the number of inflammatory joints and RA disease activity, whereas other studies showed improved the marker. And almost studies were performed by high-load resistance training protocols. Meanwhile lately Schoenfeild showed that muscle hypertrophy can be equally achieved across a spectrum of load ranges with meta-analysis2).ObjectivesTo investigate the efficacy of low-load resistance exercise of low extremity protocol on RA.MethodsTwenty-four patients with RA were enrolled. Inclusion criteria were receipt of a stable dose of biologics, JAK inhibitory, and conventional DMARDs more than 3months prior to the first exercise, and corticosteroid and NSAIDs more than one month prior to the first exercise. The exercise circuits consisted of 6 different low extremity exercises intended to improve arthritis. Within the exercise circuits, each exercise was repeated 8-12 times and less than 50% of the 1-repitition maximum. The exercise circuits were performed 3 times a week. Disease activity parameters and inflamed joint of upper extremity and lower extremity were collected at base line and 2 months after exercise started. The Wilcoxon signed-rank test was used to examine the difference between the parameter of the base line and the 2 months.ResultsAll patients were female. Mean age was 68.7 years., and mean disease duration 15.3 years. Seven patients (29%) used methotrexate, 5 patients (21%) used prednisolone and 13 patients (54%) used biologics. Mean DAS28(ESR) was 3.98 at base line and 3.58 at 2 months, mean DAS28(CRP) 3.46 and 3.06, mean SDAI 15.4 and 12.5, and mean CDAI 14.5 and 11.5, and mean upper extremity joint tenderness 4.7 and 3.7, mean upper extremity joint swelling 1.6 and 1.8, mean lower extremity joint tenderness 5.8 and 2.2, mean lower extremity joint swelling 4.0 and 2.0 respectively. Every index except upper extremity joint swelling improved significantly (p<0.05) at 2 months than baseline.ConclusionLow intensity exercise of low extremity was efficacious against not only lower extremity arthritis but also upper extremity joint arthritis in patients with rheumatoid arthritisReferences[1] Fabiana B Benatti, Bente K Pedersen: Exercise as an anti-inflammatory therapy for rheumatic diseases-myokine regulation. Nat Rev Rheumatol 11: 86-97, 2015.[2] Brad J Schoenfeld, et al.: Strength and hypertrophy adaptations low- vs. high-load resistance training a systemic review and meta-analysis. Strength Cond Res 31(12): 3508-3523, 2017Disclosure of InterestsNone declared