RA (N ¼ 15) PsA (N ¼ 15)

Age (Mean yrs ± SD) 47.1 ± 11.2 45.3 ± 9.7

Gender (M:F) 4:11 5:10

Disease duration 24 ± 36.09 24 ± 38.71

i n d i a n j o u r n a l o f r h e uma t o l o g y 9 ( 2 0 1 4 ) S 7eS 6 7S30

A contrast MRI and ultrasonography of wrists were done in each

patient and patients were followed up monthly clinically for

finding out disease evolution.

Result: The median age of the patients was 42 years and median

follow-up 9 months. There were no difference in baseline clinical

variables like DAS 28, HAQ DI (health associated questionnaire

disability index), disease duration and seropositivity between the

group evolving into RA and having spontaneous resolution (viral

arthritis). The radiological parameters like MRI erosion score (5.7

vs 0, P¼0.04), USG synovitis score (1.5 vs 0.4,P¼0.039) and presence

of erosion by USG (P¼0.001) were significantly different. However,

we could not find out any independent predictor of early arthritis

evolving into RA.

Conclusion: Radiological parameters and not the clinical variables

were different between those evolving into RA or having sponta-

neous resolution (viral arthritis).

(Median ± SD)

CRP (mean) 14.07 ± 13.56 22.6 ± 10.45

WRIST (N¼9) Variable Median

scores

p value

RA PsA

Bone Marrow

Edema(BME) (n ¼ 72)

25 5 0.01

Erosions (n ¼ 72) 26 10 0.04

IP of thumb

(N¼15)

Synovitis (n¼15) 1 8 <0.001BME (n ¼ 30) 1 4 <0.001

MCP (N¼15) BME (n¼ 150) 3 38 0.004

PIP (N¼15) Synovitis (n ¼ 60) 17 29 <0.001

Periosteal inflammation (PI), bone proliferation (BP) and diaphyseal

marrow edema (DME) were exclusive findings in PsA.

Reversible

amenorrhea(10)

Irreversible

amenorrhea(3)

SLEDAI >10 when diagnosed 10 2

Menstrual status at diagnosis Amenorrhea

(10/10)

Normal(3/3)

Average Age while starting

cyclophosphamide(years)

23 36.3

Average Cumulative Dose of

Cyclophosphamide (grams)

5.25 7

Regimen(NIH/EUROLUPUS) 4/6 1/2

Average duration of reversibility 12.5 months Irreversible

SLEDAI of <5 after

cyclophosphamide

9 3

P80. Effect of methotrexate on circulating T-helper subsets inrheumatoid arthritis

Prabhdeep Kaura, Varun Dhira, Amit Sandhua, Ankita Sooda,

Veena Dhawanb, Nidhi Guptaa, Aman Sharmaa,

Shefali Sharmaa; aDepartments of Internal Medicine andbExperimental Medicine and Biotechnology, PGIMER, Chandigarh, India

Introduction: Methotrexate is the most popular DMARD for

Rheumatoid arthritis however, its effect on circulating T-helper

subsets is unclear. This study looked at changes in frequencies of

these subsets after treatment with methotrexate.

Methods: Patients having rheumatoid arthritis (1987 ACR), with

active disease and not on methotrexate were enrolled. Metho-

trexate was started at 15 mg/week with escalation to 25mg by 8

weeks and continued till 24 weeks. Peripheral blood mono-

nuclear cells were isolated and frequencies of T helper subsets

(as %CD4T cells) were determined at baseline and 24 weeks.

Briefly, after surface staining, cells were stimulated with PMA

(50ng/ml) and Inomycin (1ug/ml) for 5.5 hours at 37C. After

fixation and permeabilization, intracellular cytokine staining for

IFNg (Th1), IL4 (Th2) and IL17 (Th17) was done. Comparison of

frequencies was done by paired t-test.

Results: This study included 20 patients (18 females) having

mean±SD age 41.3±8.5 years and disease duration 2.4±1.6 years.

DAS28(3) declined from 6.3±0.9 to 5.1±1.0 at 24 weeks (p<0.001).

Therewas decrease in the proportion of Th1 cells onmethotrexate

treatment from 13.9±10.6% at baseline to 7.7±5.8% at 24 weeks

(p¼0.03). There was a decline in Th2 cells from 2.1±2.1 to 0.7±0.8%

(p¼0.02) but no significant change in the Th17 cells (3.4±0.9,

2.4±0.8%, p¼0.7) at 24 weeks.

Conclusions: In this small study, we found methotrexate to be

associated with a decline in Th1 and Th2 cell frequencies in pe-

ripheral blood but no change in the Th17 frequency.

P81. Office extremity magnetic resonance imaging of thehands without contrast enhancement e differences betweenrheumatoid and psoriatic arthritis

Ashish J. Mathewa, Jyoti Panwarb, Irene Francisa, Varghese Koshya,

Debashish Dandaa; aDepartments of Clinical Immunology andRheumatology and bRadiodiagnosis and Imaging, Christian MedicalCollege, Vellore, India

Introduction: Psoriatic arthritis (PsA) can mimic Rheumatoid (RA).

Office extremity MRI is a sensitive tool for small joints.

Methods: Extremity MR(0.2-T Esaote C-scan; Genova, Italy) images

of RA (1987 ACR criteria) and PsA (CASPAR criteria) hands (wrist and

fingers)werestudied.Patientsmatched fordiseasedurationandage

over last 1 year were included. Two blinded investigators reported

images (Cor-GE-STIR, Cor-3D-T1W, Tra-TSE, Tra-GE-STIR, Sag-SE)

independently using OMERACT-RAMRIS and PsAMRIS scoring sys-

tems. Inter-observer reliability was calculated using correlation

coefficient method. Chi-square test compared both groups.

Results: An ICC of >0.9 was obtained in all four variables at wrist

and small joints. Findings were:

Conclusion: Office e-MRI can differentiate RA from PsA by PI, BP,

DME and BME as significant determinants.

P82. Reproductive health in SLE

Rushabh Kothari, Amol Raut, Amol Kamble, Lalana Kalekar,

Yojana Gokhale; Rheumatology Services, Department of Medicine,Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India

Introduction: SLE, predominantly seen in females of reproductive

age, has bearing on women's reproductive health. Indian data is

limited.

Methods: Serial recruitment of SLE patients fulfilling the ACR

criteria for lupus aged >13years.

Results: 52 patients were studied. Thirteen(25%) patients had/

developed amenorrhea:10 reversed and 3 developed premature

menopause.

i n d i a n j o u rn a l o f r h e uma t o l o g y 9 ( 2 0 1 4 ) S 7eS 6 7 S31

Sixteen pregnancies in 11 patients out of 37married patients were

studied. Three maternal complications occurred: Preeclamp-

sia(APA-ve),postpartum hemorrhage and maternal mortality due

to disseminated tuberculosis at 8months of gestation. Flares were

seen in 7 patients(nephritis-3), of 7 patients,3 were APAþve.

Out of 16 pregnancies,9 live births occurred:7 normal vaginal de-

livery and 2 planned LSCS;5 preterm(2 LowBirthWeight) and 4 full-

term. Seven pregnancies weren't successful:2 IUFD,3 first

trimester spontaneous abortion,1 MTP and one maternal

mortality. Mothers were treated with steroids,hydroxy-

chloroquine,aspirin (if APAþve),azathioprine (if required for LN).

Successful

Pregnancy(9)

Unsuccessful

pregnancy(7)

Low SLEDAI at conception 6 2

No.of patients with flare 2(1 LN) 5(2 LN)

APA+ve 1 4(2 abortion,

1 IUFD)

Anti Ro/La 0 1(IUFD)

Average steroid dose(mg/day) 10 30

Conclusions: Amenorrhea in young was due to high disease ac-

tivity which reversed on treating irrespective of cyclophospha-

mide dose/regimen. In older patients treated with

cyclophosphamide amenorrhea was irreversible. Successful

pregnancy is possible if planned when disease is controlled.

Antiphospholipid antibodies and flare(esp. nephritic) have nega-

tive impact on pregnancy outcome.

P83. Complement Receptor 1 (CR1) gene polymorphisms inSystemic Lupus Erythematosus (SLE) patients and theirassociation with clinical expression of the disease

Vandana Pradhana, Sangeeta Paulc, Vinod Umarea,

Manisha Patwardhana, Milind Nadkarb, Anjali Rajadhyakshab,

Alok Dhawanc, Kanjaksha Ghosha; aDepartment of Clinical andExperimental Immunology, National Institute of Immunohaematology,Indian Council of Medical Research, Mumbai, India; bDepartment ofMedicine, King Edward Memorial Hospital, Mumbai, India; cInstituteof Life Sciences, Ahmadabad University, Gujarat, India

Background: Complement Receptor 1 (CR1) is amonomeric single-

pass type 1 membrane glycoprotein mediating the binding and

transport of immune complexes (ICs) to phagocytes. A number of

studies have reported the association of the CR1 polymorphisms

with Systemic Lupus Erythematosus (SLE). The aim of this study

was to explore whether the single nucleotide polymorphisms

(SNPs) of CR1 gene in exon 22 (1208A/G) and exon 33 (1827C/G) are

associated with susceptibility of SLE.

Methods: SLE patients were clinically examined by ACR criteria

and the disease activity was assessed by using SLEDAI after

obtaining requisite ethical committee permission. Genomic DNA

of 50 SLE patients and 50 age and sex matched normal healthy

individuals were genotyped by PCR-RFLP method. Genotyping

results were compared with phenotype expression of the disease

and autoantibodies.

Results: CR1 analysis showed the significant prevalence of variant

genotype, 1208GG (OR: 4.947, 95% Confidence Interval [CI]: 1.301-

18.808, p: 0.018) and the allele, 1208G (OR: 2.241, 95% CI: 1.248-

4.004, p: 0.006) among patients compared to controls. Further

analysis showed the combined occurrence of 1208GG and AG

genotype was associated with the arthritis manifestation of SLE.

CR1 1827C/G showed no significant association with SLE.

Conclusion: Nevertheless, CR1 (1208A/G) polymorphism may

constitute as a risk factor for the susceptibility of the disease.

However, the study needs to be extended to investigate more

number of patients.

P84. An old parameter in a new avatar!!!! e QT interval inSLE

S. Sham, N. Thilagavathi, T.N. Tamilselvam, S. Rajeswari;Department of Rheumatology, Madras Medical College, Chennai, India

Introduction: SLE needs periodic assessment of disease activity

with various markers like complements, ds DNA which are quite

costly in a country like ours. So the aim of this study was to find a

surrogate marker for the same which would be readily available

and cheaper.

Aim: 1. To study any correlation between QT interval parameters

(QTc interval & QT dispersion) on Electrocardiogram (ECG) and

disease activity (SLEDAI) in patients with SLE.

2. To study QT interval parameters during episodes of flare.

Methods: The study was done on 100 newly detected SLE patients

and 100 age matched controls between January 2012 e December

2013.

Results: In our study, 84% had high disease activity (SLEDAI> 10). 51

among cases & 6 among controls had QTc> 440 msec. QTd was

prolongedamong6cases and6 controls. ThemeanQTc intervalwas

436.30msec (S.Dof27.43)amongcasesand397.24msec (S.Dof31.85)

among controls which was statistically significant (p<0.001; Lev-

ene's Test for Equality of Variances). The mean QTd among cases

was 44.40msec (S.D of 20.61) and 39.2 (S.D of 17.7) among controls

which was not statistically significant (p<0.057). Difference of QTc

valuesduring severeflare frombaselineQTcvalueswas statistically

significant (r¼0.863; Pearson's correlation coefficient).

Conclusions: This study emphasizes the increased prevalence of

QTc prolongation in SLE patients with high disease activity. So,

QTc interval may be used as a surrogate marker for assessing

disease activity in SLE.

P85. Pachymeningitis as the presenting manifestation ofSystemic Lupus Erythematosus (SLE)

Hegde Arun, Shanmuganandan Krishnan, D.S. Bhakuni,

Kumar Abhishek, Atal Amar Tej; Department of Rheumatology,Army Hospital Research and Referral, Delhi Cantt, India

Introduction: Pachymeningitis is characterized by focal or diffuse

thickening of the dura mater and is uncommonly associated with

systemic connective tissue disorder. Hereinwe report the case of a

young girl with pachymeningitis as the presenting clinical mani-

festation for her underlying SLE.

Methods: A 12 yr old girl with no known previous illness presented

with severe headache for two weeks. Baseline clinical evaluation

was normal. There were no clinical signs of raised intracranial

tension. Magnetic resonance imaging (MRI) of the brain done for

persistent headache showed mild pachymeningeal thickening

and contiguous post contrast enhancement over bilateral cerebral

hemispheres suggestive of pachymeningitis. Cerebrospinal fluid

(CSF) examination revealed high opening pressure, normal

biochemistry, negative bacterial, fungal and mycobacterial cul-

tures, negative PCR for viral etiology and negative cytology for

malignant cells.