Objective To evaluate fenebrutinib, an oral and highly selective noncovalent inhibitor of Bruton's tyrosine kinase (BTK), in patients with active rheumatoid arthritis (RA). Methods Patients with RA and an inadequate response to methotrexate (MTX) (cohort 1; n = 480) were randomized to receive fenebrutinib (50 mg once daily, 150 mg once daily, or 200 mg twice daily), adalimumab (40 mg every other week), or placebo. Patients with RA and an inadequate response to tumor necrosis factor inhibitors (cohort 2; n = 98) received fenebrutinib (200 mg twice daily) or placebo. Both cohorts continued MTX therapy. Results In cohort 1, the percentages of patients in whom American College of Rheumatology 50% improvement criteria (ACR50) was achieved at week 12 were similar in the fenebrutinib 50 mg once daily and placebo groups, and were higher in the fenebrutinib 150 mg once daily group (28%) and 200 mg twice daily group (35%) than in the placebo group (15%) (P = 0.016 and P = 0.0003, respectively). Fenebrutinib 200 mg twice daily and adalimumab (36%) were comparable (P = 0.81). In cohort 2, ACR50 was achieved in more patients receiving fenebrutinib 200 mg twice daily (25%) than placebo (12%) (P = 0.072). The most common adverse events in the fenebrutinib groups included nausea, headache, anemia, and upper respiratory tract infections. Fenebrutinib had significant effects on myeloid and B cell biomarkers (CCL4 and rheumatoid factor). Fenebrutinib and adalimumab caused overlapping as well as distinct changes in B cell and myeloid biomarkers. Conclusion Fenebrutinib demonstrates efficacy comparable to adalimumab in patients with an inadequate response to MTX, and safety consistent with existing immunomodulatory therapies for RA. These data support targeting both B and myeloid cells via this novel mechanism for potential efficacy in the treatment of RA.

Background Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Magnetic resonance imaging (MRI) is currently used not only to facilitate early diagnosis of the AS, but also to monitor the course of inflammation. Objectives To evaluate the differences in clinical and functional impairment for different duration of the disease in AS patients with and without of active inflammation on MRI. Methods Study involved 40 people (males) with AS and disease duration <10 years and >10 years. The patients were divided into two groups: Group I – patients without inflammation on MRI or with postinflammatory changes (20 people), Group II – patients with inflammation on MRI (20 people). All evaluation parameters: 10-point assessment of mobility of the spine in the cervical (neck rotation), thoracic (lateral flexion), lumbar parts (modified Schober test), indexes BASMI, BASDAI. All patients underwent MRI of sacroiliac joints and the spine. Results Between groups 1 (without inflammation on MRI) and 2 (with inflammation on MRI) were obtained following differences: index BASDAI: <10 years disease duration: 4,10±1,0 vs 4,03±0,48; >10 years of disease duration: 2,36±0,40 vs 3,92±0,35 (p<0,05). Mobility in the cervical parts of spine: <10 years disease duration: 2,75±0,47 vs 5,22±0,52 (p<0,05); >10 years disease duration: 7,49±0,46 vs 7,40±0,35. Mobility in the thoracic parts of spine: <10 years disease duration: 3,50±0,28 vs 6,22±0,72 (p<0,05); >10 years disease duration: 8,50±0,39 vs 8,60±0,65. Mobility in the lumbar parts of spine: <10 years disease duration: 5,75±0,25 vs 8,55±0,50 (p<0,05); >10 years disease duration: 9,81±0,34 vs 9,40±0,55. Index BASMI: <10 years disease duration: 2,60±0,41 vs 4,38±0,38 (p<0,05); >10 years disease duration: 6,06±0,25 vs 5,92±0,41. Conclusions In patients with active inflammation on MRI mobility impairments were significantly higher in all parts of the spine in the early stages of the disease (up to 10 years AS duration), and disease activity was significantly higher than in patients without osteitis at disease duration over 10 years. This indicates a lower quality of life for patients with active inflammation on MRI as on the early so on the late stages of the disease. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2663

Background Ankylosing spondyloarthritis (AS) is a chronic inflammatory rheumatic disease. Lesion of zygapophysial joints is characterized by more unfavorable course of disease. Objectives To estimate the lesion frequency of the zygapophysial joints by MRI and its impact on vertebral function in patients with AS. Methods The study involved 53 people (males) with AS and disease duration ≤ 10 years. The patients were divided into two groups: Group I – patients without lesion of zygapophysial joint but have syndesmophytis (18 people), Group II – patients with lesion of zygapophysial joint (35 people). All evaluation parameters: 10-point assessment of mobility of the spine in the cervical, thoracic, lumbar parts. Results Zygapophysial joint lesion has a high prevalence at onset disease (61,40%) and precedes, in most cases, by lesions of the vertebral body and ligaments. Involvement of that kind met mostly in patients with peripheral form of the disease: 25 patients (71.42%), especially if the peripheral joints were affected at onset disease. Spinal mobility’s indicants in patients without zygapophysial joint lesions but with the presence of syndesmophyte: neck rotation 1.94 ± 0.70 points, chest excursion 4.32 ± 0.57 cm, lateral flexion 2.88 ± 0.85 points, modified Schober test 5.33 ± 0.83 points. Spinal mobility’s indicants in patients with zygapophysial joint lesions: neck rotation 4.57 ± 0.38 points, chest excursion 2.79 ± 0.27 cm, lateral flexion 5.22 ± 0.41 points, modified Schober test 7.87 ± 0.35 points. We also notified the correlation between the quantity of affected joints and intensity of functional changes in spine mobility. Conclusions We observed the correlation between severity of function changes in the cervical and lumbar spine, chest excursion and the presence of facets joints lesions. The differences between groups with and without facet joint lesions were statisticaly significant, that indicates more unfavourable prognosis for a clinical course. Disclosure of Interest None Declared