222 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0679 Rheumatology
Comparisons of Radiographic Progression of Ankylosing Spondylitis Between Treatment with Tnf Antagonist, Continuous Treatment with Nsaid, and on Demand Treatment of Nsaid
Hong Ki MIN1, Jin Young KANG1, Jung Hee KOH1, Seung Min JUNG1, Jennifer LEE1, Ji Yeon LEE1, Seung-Ki KWOK1, Ji Hyeon JU1, Wan-Uk KIM1, Sung-Hwan PARK1 The Catholic University of Korea, Seoul St. Mary’s Hospital, Korea1
Background: We investigated radiographic progression of ankylosing spondylitis (AS) pa- tients treated with TNF antagonist, continuous NSAID, and on demand treatment of NSAID.
Methods: This retrospective single-center study included 41 Korean AS patients who fulfi lled the 1984 Modifi ed New York criteria for AS or 2009 ASAS criteria for classi- fi cation of spondyloarthritis from January 2006 to June 2014. Patients who had been checked lateral cervical and lumbar radiographs at baseline, after 4 years, and 8 years were included. Radiologic progressions were measured by calculating modifi ed Stokes AS spinal score (mSASSS) and number of syndesmophytes. Oneway analysis of vari- ance and Kruskal-wallis test were used for assessing comparisons.
Results: Patients in TNF antagonist (n=14), continuous NSAID (n=12), and on demand NSAID (n=15) did not show difference in baseline characteristics and radiologic status (mSASSS score and number of syndesmophyte). Laboratory datas of ESR were higher in TNF antagonist group when compared with continuous NSAID group and on de- mand NSAID group (TNF antagonist vs continuous NSAID; 39.0 (9.8-71.8) vs 6.0 (4.3- 13.6), p=0.002, TNF antagonist vs on demand NSAID; 39.0 (9.8-71.8) vs 7.0 (3.0-33.0), p=0.013). Radiographic progressions measured by mSASSS and number of syndes- mophytes were differed signifi cantly between TNF antagonist group and continuous NSAID group at 8 years: 7.5 (3.8-16.2) mSASSS change in TNF antagonist group versus 5.0 (2.0-6.0) in continuous NSAID group (p=0.040), 2.0 (0-5.2) syndesmophyte change in TNF antagonist group versus 1.0 (0-3.0) in continuous NSAID group (p=0.038).
Conclusions: In our study, continuous NSAID treatment group showed less radiographic progressions of AS than TNF antagonist treatment group. Continuous NSAID usage may have superior effect on blocking the progression of new bone formation in AS, hence physicians may consider continuous NSAID treatment regardless of patient’s symptoms.
PS 0680 Rheumatologyy
A Case Report of SAPHO Syndrome Treated with Alen- dronate
Hyun-Ik SHIM1, Seong-Ryul KWON1, Won PARK1, Ji-Hyeon BAEK2, Yeo-Ju KIM3, Kyong-Hee JUNG1, KoWoon JOO1, Mie-Jin LIM1
Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Korea1, Division of Infectious Diseases, Department of Internal Medicine, Inha University Hospital, Korea2, Department of Radiology, College of Medicine, Inha University Hospital, Korea3
Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) syndrome is an oste- oarticular-skin syndrome characterised by sterile infl ammatory arthro-osteitis of the anterior chest wall. Due to its diverse musculoskeletal and skin manifestations, SAPHO syndrome is very hard to diagnose and despite the effect of empirical treatment with steroids and DMARD, there is not enough clinical studies to establish proper treatment protocol. We report a case of SAPHO syndrome presenting anterior chest wall pain and pustulosis who was successfully treated with alendronate.
PS 0681 Rheumatologyy
The Case of the Idiopathic Primary Hyperthrophic Os- teoarthropathy with Clubbing Fingers and Toes
Heejin PARK1, Yoo Mee KIM2, Eun Young CHOI2, Mi Il KANG3
Department of Rheumatology, International St.Mary`s Hospital, Korea1, Department of Endocrinology, International St.Mary`s Hospital, Korea2, Department of Rheumatology, Dankook University Hospital, Korea3
A 41 years old female visited the outpatient clinic of rheumatology for enlarged fi n- gertips and joints and arthralgia. She had no medical history. Her height was 168.4cm and body weight was 63 kg. Her every fi ngertips and toes showed abnormal enlarged and rounded appearances. She remembered that the changes of fi ngertips and toes had been developed since six years old. And elbow and knee joints were enlarged, but not tendered. She had only mild pain on the joints. She had no obvious symptoms of breathing diffi culty or chest pain and no sign of cyanosis. Blood pressure was 119/65 mmHg, heart rate was 78 per minute and body temperature was 36.5 ℃. White blood cell count was 4770 /μL, hemoglobin was 12.8 g/dL and platelet count was 280,000/
μL. The levels of calcium and phosphorus were 8.5 mg/dL and 3.8 mg/dL, and 25-(OH) vitamin D was 17.7ng/mL (defi ciency : <10.0, insuffi ciency: 10.0 - 30.0). SGOT and SGPT were 16 U/L and 9 U/L, and alkaline phosphatase was 56 U/L. An arterial blood gas study showed that pO2 was 119 mmHg, pCO2 was 44 mmHg and O2 saturation was 99 %. Growth hormone was 0.10 ng/mL (normal range of adult =8.00) and so- matomedin-C(IGF-1) was 84.6ng/mL (normal range between 41-45 years old: 101 – 267). Hand and foot X-ray showed that acro-osteolysis of the terminal phalanges and periosteal thickness of phalanges. And femur and tabular bone of knee X-ray also had periosteal thickness. Chest X-ray showed no defi nite cardiomegaly and left atrium en- largement. EKG was a mild sinus bradycardia. And chest CT demonstrated no defi nite abnormal fi ndings in the lung parenchyme. So, we concluded that she had the primary hyperthrophic osteoarthropathy, started nonsteroidal antiinfl ammatory drugs for her arthralgia.
