P1 A prospective study of YISAIPU, one TNF blocker, in Chinese RA and AS patients Chunde Bao Vice President of Chinese Rheumatology Association; Director, Department of Rheumatology, Shanghai Renji Hospital, Shanghai, China Background: The chemical essence of YISAIPU is as same as of etanercept. YISAIPU is developed and manufactured by Shanghai CP Guojian Pharmaceutical Co. Ltd. In 2005, YISAIPU is the first biologic to receive the Chinese SFDA’s approval for the treatment of rheumatic disease. The indications of YISAIPU now include rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriasis. Objective: To observe the safety of YISAIPU when widely used in Chinese RA and AS patients. To establish YISAIPU registered patients database, so providing data source for long-term safety observation. Method: Under the leadership of the Chinese Rheumatology Association, more than twenty rheumatology centers involved in this project. Eligible patients should be RA and AS patients who received YISAIPU since February 1, 2008. The period of observation end is indefinite, but is determined by the actual treatment duration of YISAIPU. The follow-up frequency is once a month. The primary endpoint is the number and the proportion of a variety of adverse events. The secondary endpoints is the efficacy of YISAIPU with different dose and usage. Result: As of March 2008, we have registered 1006 patients, but only 407 cases have com- plete data. The baseline characteristics of patients are as follows. The total number of RA and AS patients was 147 and 229 respectively. The proportion of male patients in the RA and AS was 23.1% and 80.8% respectively. The average age of RA and AS patients were 49.1 years (SD:17) and 31.4 years (SD:17) respectively. The duration of the two groups of patients were 7.6 years (SD: 6.6), 4.8 years (SD:6.7) respectively. On the baseline, the proportion of patients of the two groups with combination DMARDs were more than 80%, while the con- comitant use of NSAIDs more than 40%. The baseline use of hormones in the RA and AS was 23.1% and 3.1% respectively. The number of adverse events (percentage) occurred in RA and AS group were 20 (13.6%) and 20 (8.7%) respectively. The corrected exposure of YISAIPU of RA and AS groups was 0.89 and 0.45 patient-year respectively. The most common adverse events were injection-site reactions and rash. No tuberculosis occurred during the follow- up. Prior to application of YISAIPU, the tuberculin skin test rates in RA and AS groups were 37.4% and 41.5% respectively, the chest X-ray examination rates of RA and AS were 64.6% and 58.5% respectively. In RA and AS groups, the PPD-positive rate of less than 15%, the chest X-ray positive rates were 6.3% and 0.7% respectively. Prior to the treatment with YISAIPU, the HBsAg detection rates in RA and AS group were 44.2% and 48.9% respectively. The HBsAg positive rates were 6.2% and 8.0% respectively. During follow-up, no recurrence of HBV DNA replication, or active viral hepatitis. Among the kinds of duration of YISAIPU, the highest proportion in RA group was 90–180 days (33.3%), the second is 60–90 days (21.8%). The highest proportion in AS group is of ≤ 30 days (31.0%), followed by 90–180 days (27.1%). Starting on the half-dose applications in RA and AS group are not uncommon, the corresponding rates were 39.0% and 40.6% respectively. The proportion of starting on the application of sufficient quantities of YISAIPU in RA and AS group were 59.9% and 55.9% respectively. On the 12th month, those rates declined slightly. Rest pain VAS, morning stiff- ness time, ESR, CRP of RA and AS group and the swollen joints count in RA group improved rapidly and significantly across six months treatment of YISAIPU. Conclusion: In the most year-long follow-up period, the safety of YISAIPU for RA and AS was good and no TB occurred. On the sixth month of YISAIPU treatment, compared with base- line, morning stiffness, rest pain, ESR, CRP of RA and AS patients has been clearly improved. P2 Causes of in hospital mortality in SLE—a retrospective study Aman Sharma, Suryanarayana BS, Susheel Kumar, Ajay Wanchu, Pradeep Bambery, Surjit Singh Department of Internal Medicine, PGIMER, Chandigarh Introduction: Systemic lupus erythrmatosus (SLE) is a systemic autoimmune disorder which causes significant morbidity and mortality. A retrospective study of causes of mortality in admitted patients with SLE was done. Methods: Death records of patients admitted with SLE from 1998 to 2008 were obtained. Demographic details, duration of illness and duration of hospital stay were recorded. Disease activity was systematically evaluated using the SLE disease activity index (SLEDAI). Definitive and supportive treatment provided, were noted. Evidence of infection and its focus were noted. Cause of death was determined after reviewing the records. It was classi- fied into those primarily due to SLE or due to infection or multi-factorial or from unrelated causes. Results: 20 patients had died during the study period but three did not satisfy revised ACR criteria of SLE and were excluded. 15 were females and 2 were males. Average age was 26.6 years; with median being 25 years. Average duration of stay in the hospital was 10.29 days with a median of 7 days. 7 patients (41%) died active SLE (3 pulmonary haemorrhage, 2 renal failure, 1 myocarditis, 1 severe thrombocytopenia with upper GI bleed), 3 patients (18%) died of infection and in 7 patients (41%) etiology was multi-factorial (both active SLE and evidence of infection). 10 patients had clinical suggestion of infection, 8 patients (47%) has documented infection, 3 patients died primarily due to infection. Documented infections included E. coli, Tuberculosis (1), MRSA (1), Candida (1), Aspergillus (3) and Pseudomonas aeruginosa (1). Conclusion: Infection and disease activity alone or in combination are the main cause of in hospital mortality in SLE. P3 Wegener’s granulomatosis patient presenting with bilateral parotid gland swelling, submandibular gland swelling and sicca symptoms mimicking Sjogren syndrome Aman Sharma, Susheel Kumar, Ajay Wanchu, Surjit Singh Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh Introduction: Wegener’s granulomatosis presenting as Parotid gland enlargement and dryness of eyes is rare. Case Description: A 24-year-old female presented with history of painful swelling of bilat- eral parotid and submandibular salivary glands. She also complained of feeling of grittiness in both eyes. She was being treated as a case of primary Sjogren’s syndrome based on the clinical history and schirmer’s test being positive. She presented with complaints of high grade fever of 20 days; cough with mucopurulent expectoration and intermittent hemoptysis of 7 days. Examination revealed large oral ulcers and two punched out ulcers at buttocks. She developed increasing shortness of breath after admission. Investigations revealed neutrophilic leucocytosis, thrombocytosis, active sediments in urine and confluent areas of ground glassing in bilateral lung fields on HRCT. Possibility of systemic vasculitis with DAH was kept and methyprednisolone pulses were started. C-ANCA was positive and skin biopsy showed pyoderma gangrenosum. She developed one episode of GTCS in hospi- tal. MRI brain and PNS was done which showed bilateral maxillary, ethmoid and frontal sinusitis with right arachnoid cyst. She was started one gram pluse cyclophosphamide and gradually improved and was discharged. Discussion: Parotid gland enlargement as presenting manifestation is very uncommon. There are only eight cases of in literature presenting as bilateral parotid gland enlargement. Sicca symptoms have also rarely been reported in these patients. P4 Acute pancreatitis in a patient of systemic lupus erythematosus— a case report Amit Sharma, Sanjiv Kapoor, Divya Agarwal, Sri Ram Garg, Anand N Malaviya Department of Rheumatology, Indian Spinal Injuries Centre Superspeciality Hospital, Vasant Kunj, New Delhi Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune connective tissue disease that can affect any part of the body. It most often involves joints, skin and the kidneys. It may also affect the pancreas although acute pancreatitis in SLE is a rare manifestation of the disease. Methods: We present a diagnosed case of SLE who presented with relapse of polyarthritis and discoid skin lesions. She was treated with intravenous pulse glucocorticoids (IV-pulse- GC). On 3rd day, she developed epigastric pain associated with nausea. On investigations she had raised pancreatic enzymes and contrast enhanced computed tomography was sug- gestive of acute pancreatitis with normal bile canaliculi and gallbladder. Her complement levels (C3 levels 28 mg/dl, C4 3.0 mg/dl) were low with raised levels of anti-dsDNA (ELISA) 194.53 IU/ml. Results: She was treated with IV-pulse-GC and cyclophosphamide followed by oral daily glucocorticoids. Acute pancreatitis resolved slowly over a period ∼10 days with complete clearing up of the symptoms as well as return of pancreatic enzymes levels to normal range. Conclusion: Treatment of pancreatitis in SLE is controversial as glucocorticoids are among the causes of acute pancreatitis. The case presented here improved on treatment with glucocorticoids combined with cyclophosphamide. It is suggested that any patient with SLE who develops acute onset of abdomen pain, in addition of other causes, should also be evaluated for SLE-related pancreatitis. P5 Vaccination as a triggering agent for the development of rheumatoid arthritis— a case report Amit Sharma, Sanjiv Kapoor, Divya Agarwal, Sri Ram Garg, Anand N Malaviya Department of Rheumatology, Indian Spinal Injuries Centre Superspeciality Hospital, Vasant Kunj, New Delhi Background: Vaccines are known to trigger the onset of several autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), dermatomyositis (DM) and reactive arthritis. The common vaccines implicated include influenza, hepatitis B and tetanus toxoid vaccines. Here we present a case of RA that developed after exposure to rabies vaccination. Abstracts of papers presented in IRACON—2009 Poster presentations S7 Poster Presentations