The resolution of inflammation is now known to be an active process, armed with a multitude of mediators both lipid and protein in nature. Melanocortins are peptides endowed with considerable promise with their proresolution and anti-inflammatory effects in preclinical models of inflammatory disease, with tissue protective effects. These peptides and their targets are appealing because they can be seen as a natural way of inducing these effects as they harness endogenous pathways of control. Whereas most of the information generated about these mediators derives from several acute models of inflammation (such as zymosan induced peritonitis), there is some indication that these mediators may inhibit chronic inflammation by modulating cytokines, chemokines, and leukocyte apoptosis. In addition, proresolving mediators and their mimics have often been tested alongside therapeutic protocols, hence have been tested in settings more relevant to real life clinical scenarios. We provide here an overview on some of these mediators with a focus on melanocortin peptides and receptors, proposing that they may unveil new opportunities for innovative treatments of inflammatory arthritis.

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Background:New 2017 British Society of Rheumatology guidelines have recommended baseline formal ophthalmic examination, ideally including objective retinal assessment for example using optical coherence tomography, within 1 year of commencing an antimalarial drug. While the feasibility and costing of this recommendation is being assessed, we audited the current risk assessment for hydroxychloroquine prescriptions (HCQ) against the American College of Ophthalmology (ACO) guidelines for HCQ published in 2016. Table 1 shows the clinical criteria for assessment.Methods:We identified all prescriptions of HCQ documented on the electronic patient records (EPR) from January to September 2017 by the Rheumatology department of Croydon University Hospital. This generated 237 records of which 114 were new prescriptions and 117 were continuation prescriptions. 8 records were excluded due to inadequate patient compliance. Cumulative doses were estimated from dates in the EPR going back to 2013Results:New patient records were assessed for compliance with the ACO guidelines. Patients were assessed for kidney function, pre-existing renal disease, pre- existing eye disease. 74.6% patients were counselled regarding side effects and were advised to have optician retinal screening and 3.5% who had pre-existing eye disease were referred to ophthalmologists. 50.0% of patients had their weight documented prior to prescription. There was no documentation of dose calculated by weight. The commonest indication for HCQ were Systemic Lupus Erythmatosis, Inflammatory Arthritis and Sjogren’s Syndrome. 13.2 % discontinued HCQ due to side effects. The commonest side effects were diarrhoea, dizziness, rashes, and mood swings.Long- term patient records were assessed for cumulative dose of HCQ estimated from documentation. The average cumulative dose for these patients was with a maximum of 810,000 mg and a minimum of 49,600 mg. Overall, 3.0% percentage of patients did not have cumulative doses calculated due to documented compliance issues and 64.0% of patients had tightly monitored renal function.Table 1Clinical criteria for HCQ risk assessment based on American College of Ophthalmology guidelines (2016)Conclusions:50% of patients had weight documented prior to prescription and this was not used to determine dosage. The majority of patients were well informed regarding side-effects of HCQ, had tightly monitored renal function and advised to have baseline retinal screening.Disclosure of Interest:None declared

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