Scientific Abstracts
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`Saturday, 14 june 2014
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`in the others. We also evaluate the usefulness of procalcitonin for differentiating
`diagnosis between acute gout arthritis and bacterial infection.
`Methods: The serum samples were obtained from 67 patients with acute gout
`arthritis and 90 age-matched patients with bacterial infection. Serum procalcitonin
`levels were measured by an enzyme-linked fluorescent assay.
`Results: The serum procalcitonin levels in patients with acute gouty arthritis were
`significantly lower than those in patients with bacterial
`infection (0.096±0.105
`ng/mL vs 4.941±13.763 ng/mL, p =0.001). However, other inflammatory param-
`eters, such as ESR, CRP and WBC, showed no significant differences between
`these two groups. Patients with acute gout arthritis had statistically higher serum
`uric acid levels than the patients with bacterial
`infection (7.62±2.03 mg/dL vs
`5.19±2.36 mg/dL, p<0.001); however, 19.4% (13/67) among the acute gout
`arthritis group had lower uric acid level (below 6.0 mg/dL). To determine the
`discriminative ability of procalcitonin between acute gout arthritis and bacterial
`infection, we conducted ROC analysis about procalcitonin, uric acid, ESR, CRP
`and WBC. The area under the curve (AUC) of procalcitonin and uric acid were
`0.852 (95% CI 0.793-0.911, p<0.001) and 0.808 (95% CI 0.738-878, p<0.001),
`respectively. There was no significance at ESR, CRP and WBC. With a cut off
`value of 0.095 ng/dL, the sum of sensitivity and specificity of procalcitonin were
`the highest (80.0% and 80.6%, respectively).
`Conclusions: Serum procalcitonin levels were significantly lower in patient with
`acute gout arthritis than in patients with bacterial infection. The serum procalcitonin
`level is expected to be a useful serologic marker for the differentiating acute gout
`arthritis from bacterial infection.
`References:
`[1] Simon L et al. Serum procalcitonin and C-reactive protein levels as markers
`of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis
`2004:39:206-17.
`Disclosure of Interest: None declared
`DOI: 10.1136/annrheumdis-2014-eular.4127
`
`SAT0524 PREDICTORS OF A CLINICAL RESPONSE TO
`BISPHOSPHONATES TREATMENT IN PATIENTS WITH
`COMPLEX REGIONAL PAIN SYNDROME TYPE I
`M. Manara, A. Becciolini, F. Rovelli, F. Zucchi, L. Sinigaglia, M. Varenna.
`Rheumatology Department, Gaetano Pini Institute, Milan, Italy
`Background: Complex Regional Pain Syndrome type I (CRPS-I) is a painful
`condition which can lead to potential disability. The efficacy of Bisphosphonates
`(BPS) treatment in this syndrome has been demonstrated in trials in which
`different types and dosages of BPS were investigated1,2.
`Objectives: Aim of the study was to identify variables predictive of a clinical
`response to BPS treatment in a large cohort of subjects with CRPS-I.
`Methods: A retrospective analysis of patients with CRPS-I referred to our Unit
`in the last 5 years for a treatment with intravenous BPS (Neridronate 100 mg
`for 4 infusions, Pamidronate 60 mg for 4 infusions or Clodronate 300 mg for 10
`infusions) was performed. Patients with a clinical diagnosis of CRPS-I according
`to Budapest criteria3 were included when follow up data were available. Baseline
`variables (demographic characteristics, CRPS-I site, predisposing event, duration
`of symptoms before BPS treatment,
`type of BPS used, associated clinical
`manifestations, imaging) and outcome measures (pain values) were collected.
`A clinical response to the treatment was defined as a reduction in pain on a
`Visuo-Analogic Scale (VAS) higher than 50% compared to baseline at 45-60 days
`from the beginning of the treatment4.
`Results: A total of 172 patients were included in the study, with a mean (SD) age
`of 56.7 (13.8) years. Among them, 116 (67.4%) were treated with Neridronate,
`47 (27.3%) with Pamidronate and 9 (5.2%) with Clodronate. A clinical response
`to the treatment was observed in 123 (71.5%) patients. Subjects responding to
`the treatment had a shorter duration of symptoms [median (IQR): 3 (2,5) vs
`5 (2,7); p=0.000] and showed more frequently inflammatory signs (92.7% vs
`69.8%; p=0.000). A fracture as predisposing event was more likely to be found
`in responders (53.7% vs 30.6%, p=0.006). The treatment with amino-BPS was
`associated with a higher frequency of response than Clodronate treatment (73%
`vs 44.4%; p=0.065). At multivariate analysis a “warm” inflammatory phase of the
`disease [OR (95%CI): 4.57 (1.59, 13.15)] and a fracture as predisposing event
`[OR (95%CI): 3 (1.20, 7.52)] were associated with increased odds of response to
`the treatment.
`Conclusions: The treatment of CRPS-I with intravenous BPS is more likely to be
`effective when established in an early “warm” phase of the disease. Subjects with
`a previous fracture may represent a subset of patients with a higher chance to
`benefit from BPS treatment.
`References:
`[1] Brunner F, Schmid A, Kissling R, Held U, Bachmann LM. Biphosphonates for
`the therapy of complex regional pain syndrome I - systematic review. Eur J
`Pain. 2009;13:17-21.
`[2] Varenna M, Adami S, Rossini M, Gatti D, Idolazzi L, Zucchi F, Malavolta N,
`Sinigaglia L. Treatment of complex regional pain syndrome type I with ner-
`idronate: a randomized, double-blind, placebo-controlled study. Rheumatology
`2013;52:534-42.
`[3] Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic
`criteria for complex regional pain syndrome. Pain Med 2007;8:326-31.
`[4] Forouzanfar T, Weber WE, Kemler M, van Kleef M.What is a meaningful pain
`
`reduction in patients with complex regional pain syndrome type 1? Clin J Pain
`2003;19:281-5.
`Disclosure of Interest: None declared
`DOI: 10.1136/annrheumdis-2014-eular.3734
`
`SAT0525 ENVIRONMENTAL FACTORS ASSOCIATED WITH PAGET’S
`DISEASE OF BONE OR WITH THE SQSTM1/P392L MUTATION
`CARRIAGE
`M.-C. Audet 1, C. Beaudoin 2, S. Guay-Bélanger 2, J. Dumont 2, J.P. Brown 1,
`L. Michou 1. 1Department of Rheumatology, CHU de Québec; 2CHU de Québec
`Research Centre, Quebec, Canada
`Background: Several publications have demonstrated that the most frequent
`mutation in Paget’s disease of bone (PDB), SQSTM1/P392L, leads to some of the
`phenotypic characteristics of PDB, but this single mutation is seemingly unable
`to result in the complete pagetic phenotype, suggesting that other mechanisms
`such as environmental factors may play a role.
`Objectives: Identify environmental
`factors associated with PDB or with the
`SQSTM1/P392L mutation carriage in the French-Canadian population.
`Methods: We investigated environmental factors through a questionnaire in 176
`French-Canadian patients with PDB and 147 healthy controls not carrier of the
`SQSTM1/P392L mutation. The questionnaire contained the following sections:
`socio-demographic and physical characteristics, tobacco exposure, diet, resi-
`dency, work, leisure, and contact with animals, during childhood/adolescence
`and adulthood. Associations between environmental
`factors and PDB, or
`SQSTM1/P392L mutation (86 individuals carried the mutation,
`including 48
`patients with PDB), were searched relying on Chi-squared, Fisher and t tests.
`Odds ratio (OR) and 95% confidence interval were calculated. Univariate followed
`by multivariate analysis were done for association with PDB. Correlation between
`members of same family was considered when possible. Analysis adjusted for age
`and gender were done for the association study with SQSTM1/P392L mutation.
`Results: We administered the questionnaire to 361 participants: 176 patients with
`PDB and 147 healthy controls. 86 individuals were carriers of the SQSTM1/P392L
`mutation, among whom 48 were patients with PDB and 38 were healthy
`carriers of
`the mutation.
`In univariate model, we found an association of
`PDB with, wood-fire heating in childhood (OR=2.48 (1.37-4.49), p<0.01), rural
`residency during adolescence (OR=2.09 [1.19-3.67], p<0.01) and residency
`near a farm in childhood (OR=1.77 [1.02-3.09], p=0.04). In multivariate model,
`significant association was found between PDB and wood-fire heating in childhood
`(OR=2.10[1.13-3.90], p=0.02). Male gender (OR=4.63 [2.46-8.72], p<0.01) and
`lower educational
`level (OR=2.13 [1.13-4.02], p=0.02) were also associated
`with PDB. Carriage of the SQSTM1/P392L mutation was associated with rural
`residency (OR=2.66 [1.42-4.99], p<0.01), wood-fire heating (OR=2.25 [1.20-4.24],
`p=0.01), residency near a farm (OR=2.37 [1.29-4.38], p<0.01) and work on a
`farm (OR=3.30 [1.75-6.24], p<0.01) in childhood. There was also an association
`with residency near a mine (OR=6.64 [1.68-26.27], p<0.01) and work in a
`mine (OR=6.89 [1.35-35.31], p=0.02). Interestingly, association with exposition to
`different animals during childhood were found with the SQSTM1/P392L mutation
`(p<0.05): horse, dog, sheep, pork, cattle and poultry.
`Conclusions: PDB and the carriage of
`the SQSTM1/P392L mutation were
`significantly associated with rural residency. Carriage of the SQSTM1/P392L
`mutation was also strongly associated to work on a farm or in a mine and
`exposition to some animals during childhood.
`Acknowledgements: CHU de Quebec foundation
`Disclosure of Interest: None declared
`DOI: 10.1136/annrheumdis-2014-eular.4393
`
`SAT0526 THE FREQUENCY OF CALCIUM PYROPHOSPHATE
`DEPOSITION DISEASE IN PATIENTS WITH ACUTE ARTHRITIS
`M. Eliseev, S. Vladimirov, E. Nasonov. Research Institute of Rheumatology,
`Moscow, Russian Federation
`Background: Most of
`the patients with acute arthritis are diagnosed gout.
`However, the frequency of Calcium Pyrophosphate Deposition Disease (CPPD)
`in patients with acute arthritis is not enough valuated.
`Objectives: To evaluate the frequency of CPPD in patients with acute arthritis
`and describe joint involvement in these patients.
`Methods: 150 adults with acute mono-/olygoarthritis during not more than 2
`weeks were enrolled. The mean age was 60±12 years (28-76 ys). All patients
`underwent aspiration of synovial fluid (SF) from inflamed joint (I MTP, knee or
`ankle). Crystal identification was performed using polarized light microscopy with
`compensator (Olympus CX31-P). Diagnosis of CPPD fulfilled McCarty diagnostic
`criteria. For both CPPD and gout the diagnosis was based on crystal visualization
`in SF.
`Results: Gout was diagnosed in 51 (34%), CPPD – in 45 (30%) of pts. 15 (14%)
`of pts occurred to have both CPPD and gout. 39 (26%) of pts had other diagnosis.
`There was male predominance in pts with gout (40m/11f) unlike CPPD, where we
`observed female predominance (32f/13m). Pts with gout were younger than those
`with CPPD (35,5±9 ys vs 58,4±12,8 ys, correspondingly, p<0,05). In CPPD pts
`arthritis most frequently developed in the knee joints (76,3%). Acute arthritis of
`the ankle and I MTP joints manifested in 30,3% and 10,5% of pts with CPPD. We
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`Grun. Exh. 1037
`PGR for U.S. Patent No. 9,820,999
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