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Scientific Abstracts
Disclosure of Interest: T. Zhu Employee of: Astellas Pharma Global
Development, T. Sawamoto Employee of: Astellas Pharma, Inc., U. Valluri
Employee of: Astellas Pharma Global Development, M. Lewand Employee of:
Astellas Pharma Global Development, Y. Cao Employee of: Astellas Pharma
Global Development, S. Swan: None Declared, K. Lasseter: None Declared,
M. Matson: None Declared, J. Holman Employee of: Astellas Pharma Global
Development, J. Keirns Employee of: Astellas Pharma Global Development

AB0365

CRYOTHERAPY IN RHEUMATOLOGIC INFLAMMATORY

DISEASES : A SYSTEMATIC REVIEW WITH METAANALYSIS IN NON-OPERATED PATIENTS

X. Guillot1, N. Tordi2, L. Mourot3, C. Prati1, C. Demougeot2, D. Wendling1.

1
Rheumatology Department, Hopital Jean Minjoz, 2EA 4267, 3EA 4260,
University of Franche-comt, Besancon Cedex, France
Background: Cryotherapy is used empirically as a symptomatic treatment in
rheumatology, with well-known analgesic, vasoconstrictive, anti-inflammatory
properties. It can be applied locally or to the whole body.This widespread
use contrasts with a lack of standardization in techniques and a poor level of
evidence.
Objectives: The aim of this work is to quantify cryotherapys therapeutic
effects in rheumatologic inflammatory diseases using available evidence.
Methods: We performed a systematic review (pubmed, LILACS, Cochrane
library). Keywords cryotherapy,cold,inflammation,arthritis were used
alone and in combination.We also considered abstracts from rheumatology
congresses (ACR, EULAR) and unpublished data. Selection criteria were
inflammatory rheumatologic disease patients treated with local or wholebody cryotherapy, with endpoints evaluating pain, activity and inflammation
parameters. Articles about post-operative joint cryotherapy and infectious
diseases were excluded. Results were expressed as means +/- SD (continuous
variables). A fixed effect model was used. Paired or unpaired t-tests (=5%)
were used to compare pooled means +/- SD (before/after cryotherapy and
versus control when possible).
Results: We identified 116 potentially relevant abstracts and excluded 96
articles (postoperative, non-inflammatory diseases, inadequate endpoints
or outcomes, lack of accuracy (technique, results), duplicates). Among
the 20 potentially appropriate articles for meta-analysis, 14 more were
excluded (inappropriate design or data presentation, study populations). We
finally selected 6 articles for quantitative analysis. There was no significant
heterogeneity. We could only perform quantitative analysis for 2 endpoints
(pain VAS and DAS28) in RA patients after chronic application (7 to 15 days).
-Local cryotherapy (cold packs, cold air, liquid nitrogen for 3 to 30 min (ice)
10 to 20 applications on 1-5 joints) significantly decreased pain VAS (mm)
in 68 RA patients (56,57 +/- 27,44 versus 32,5 +/- 19,99 mm ; p<10exp(-6)).
However, there was no significant difference with 17 RA patients treated with
drug therapy.
-Local cryotherapy also significantly decreased DAS28 in the same patients
(5,47+/-1,53 versus 4,56 +/- 1,19 ; p<5X10exp(-5)) ; no usable control group.
-Whole-body cryotherapy (-110 or -160C for 2 to 5 min ; 8 to 30 sessions) significantly decreased pain VAS in 124 RA patients (53,15+/-20,46 versus 35,64
+/- 26,69 mm ; p<10exp(-6)). There was again no statistical difference with 17
RA patients treated with low frequency magnetic field.
-Whole-body cryotherapy (-110C for 2 to 3 min ; 8 to 20 sessions) decreased
DAS28 significantly in 83 RA patients (4,86 +/- 0,83 versus 4,74 +/- 0,81 ;
p<10exp(-3). There wasno statistical difference with the same control group.
Physical therapy was associated to cryotherapy in 5/6 studies and drug therapy intake (NSAIDs, corticosteroids, DMARDs, biologics) was not assessed
in 5/6 studies.
Conclusions: Local and whole-body cryotherapy significantly decrease pain
VAS and DAS28 in RA patients.Further RCTs with adequate control groups
and methodology are required to calculate effect size properly.
Disclosure of Interest: None Declared

AB0366

RADIOGRAPHIC OUTCOME IN PATIENTS WITH EARLY

JAPANESE RHEUMATOID ARTHRITIS RECEIVING
CONVENTIONAL DMARDS OVER 15 YEARS OF
FOLLOW-UP

Y. Kanayama1, Y. Oishi2, Y. Hirano2, T. Kojima3, N. Ishiguro3. 1Orthopedic

Surgery and Rheumatology, Toyota Kosei Hospital, Toyota, 2Rheumatology,
Toyohashi Municipal Hospital, Toyohashi, 3Orthopedic Surgery, Nagoya
University Graduate School of Medicine, Nagoya, Japan
Background: The joint destruction in rheumatoid arthritis (RA) are well known
to progress for an onset early stage. Therefore, the treatment intervention that
is appropriate from an onset early stage is important in RA. However, there
were few reports about the progression of joint destruction for a long term with
the early Asian RA patients.
Objectives: For early Japanese RA, we performed early conventional
DMARDs treatment and analyzed radiographic progression of hands and
reviewed it in retrospective about the progression of joint destruction.
Methods: We intended for twenty Japanese RA patients which we performed
early treatment by conventional DMARDs for onset less than 1 year and were
able to follow up more than 15 years. Treatment was initiated between 1989
and 1993 at the Department of Rheumatology, Toyohashi Municipal Hospital,
and who met the diagnostic criteria stipulated by the American College of

899
Rheumatology in 1987.All cases were female, RA onset time average age
was 45.313.3 years old, the onset for average was 6.24.0 months from
the period to a DMARD start, and first DMARDs was all gold (Gold sodium
isothiomalate ; 14 cases, Auranofin ; 6 cases). Number of the tender joints ;
6.44.6, number of the swelling joints ; 3.33.4, CRP ; 3.1 3.6mg/dl, DASCRP3 ;4.120.97 at the time of the initiation, RF positive ; 17 cases (85%),
number of DMARDs for 15 years ; 3.82.0 which they used were agents, were
all non biolosics. We used modified Sharp method (van der Heidje method)
with both hands using simple radiographs and evaluated the joint destruction
at initiation, 5, 10 and 15 year.
Results: Radiographs at the time of the initiation already showed a bone
erosions in six cases, and, as for the TSS, 3.55.1 at the time of the initiation
changed into each 44.534.9, 76.042.6 and 92.348.5 at 5, 10 and 15 years.
Mean yeary progression of TSS was 7.8/y, 6.3/y and 3.3/y at 0-5 years, 5-10
years and 10-15 years.In the bone erosion-positive group (n=6) and negative
group (n = 14) at initiation, the respective changes in TSS at 5, 10 and 15 year
were as follows: 5 year: 37.3 36.2 and 61.2 27.5 (p = 0.063); 10 year : 69.9
44.7 and 90.0 36.8 (p = 0.283); and 15year : 85.4 51.6 and 108.7 39.7
(p = 0.322). In the RF-positive group (n=17) and nagative group (n = 3), the
respective changes in TSS at 5, 10 and 15 year were as follows: 5 year: 47.3
28.3 and 17.3 12.4 (p = 0.525); 10 year : 82.5 42.5 and 38.7 17.0 (p =
0.081); and 15year : 100.6 47.5 and 45.7 21.9 (p = 0.05). The correlation
between the number of use conventional DMARDs for 15 years and the TSS
at 5, 10 and 15 year were each 0.702, 0.718 and 0.711 (p<0.001, p<0.001,
p<0.001).
Conclusions: The joint destruction progressed most in first 5 years, and tended
to progress for the case to present a bone erosion at initiation in first 5 years.
In the RF-positive patients the joint destruction progressed significantly for a
long term.A control of RA was insufficient, and the case that there was much
number of conventional DMARDs to use is at risk factor of the progression of
joint destruction.
Disclosure of Interest: None Declared

SLE, Sjgrens and APS - treatment _________

AB0367

LYMPHOCYTE B DEPLETION AND MODERATE TO

SEVERE ACTIVITY IN PATIENTS WITH SYSTEMIC
LUPUS ERYTHEMATHOSUS

A. Acosta Pereira1, B. Magallares Lpez1, A. Rodriguez de la Serna1. 1Santa

Creu I Sant Pau Hospital, Barcelona, Spain
Background: INTRODUCTION:Rituximab (RTX) induces a rapid and almost
complete depletion of B cells in peripheral blood. It is used for patients with
poor response to other therapies. The pharmacologic effect of RTX. appears
to be independent of the CD20 function and is associated to complement
mediated lyses, antibody cellular dependent cytotoxicity and the induction of
apoptosis. (1-3)
Objectives: 1.- Ponder efficacy defined by the improvement of the activity
index of systemic Lupus Erythemathosus, (SLEDAI) and the progression of B
lymphocyte depletion in patients treated with RTX.
2.- Correlate SLEDAI with the number of administered rituximab infusions.
3.- Define whether there is reduction of the dosage or suspension of the glucocorticosteroids, by oral route, after the treatment with RTX.
Methods: 13 patients that had received RTX. were analyzed retrospectively.
Data reviewed before and after therapy, consisted of : anti-DNA antibody, (antiDNA), SLEDAI and prednisone dosage . B cell depletion was measured after
treatment, (defined as B-lymphocyte <1%), and the average number of RTX
infusions during the analyzed years, was also evaluated.
Results: 13 patients (76,92% female and 23,07% male), with a mean age of
44 years with the diagnosis of systemic lupus Erythematosus in the prior 1,5 to
35 years ( median 14,5 years of disease progression) that had arthritis30,76%,
lupus nephritis 23,07%,recurrent pericarditis 15,38%, hematological features
15,38%, shrunken lung 7,69%. were studied. All patients had a reduction
of anti-DNA and SLEDAI was statistically significant .( P= <0,003,Paired T
test). Anti-DNA diminution showed a variability that decreased it s potency
to be statistically significant (P= 0,172 : T Test). All patients experimented a
significant reduction of the dosage of prednisone (mean pretreatment dosage,
10 mg versus mean dosage after treatment, 5 mg) ( P= 0,004: Wilcoxon test).
Even though all patient improve by SLEDAI, this was more so in the patients
that received a larger number of infusions, establishing that the diminution of
SLEDAI was depended of the number of infusions received by the patients,
and this diminution was statistically significant .( P=0,003 :ANOVA)
There was no correlation between the the depletion of B lymphocites and the
Sledai value.(P= 0,532 : ANOVA)
Conclusions: RTX is a therapeutic option that is efficient in patients with
moderate to severe SLE that are refractory to other therapies .
The efficacy measured by SLEDAI correlates with the number of received infusions and is not related with with the B-lymphocyte depletion. Treatment with
rituximab permits to decrease significantly the dose of Prednisone.
References: 1-Jennifer H. Anolik, Jennifer Barnard, Amedeo Cappione,
Aimee E. Pugh-Bernard, Raymond E. Felgar, R. John Looney, and Inaki Sanz.
Rituximab Improves Peripheral B Cell Abnormalities in Human Systemic Lupus
Erythematosus arthritis rheum 2004; 56: 358090.
2- J. Silverman . Anti-CD20 Therapy in Systemic Lupus Erythematosus: A Step
Closer to the Clinic Gregg.
Arthritis rheum 2005; 57: 3717

Downloaded from ard.bmj.com on September 16, 2014 - Published by group.bmj.com

AB0365 Cryotherapy in rheumatologic

inflammatory diseases : a systematic review
with meta-analysis in non-operated patients
X. Guillot, N. Tordi, L. Mourot, et al.
Ann Rheum Dis 2013 72: A899

doi: 10.1136/annrheumdis-2013-eular.2687

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