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 S19

efficacy outcome measures included; improvements in the

markers of inflammation (ESR and CRP) and pro-inflammatory

cytokines TNF-a, IL-6 and IL-1.

Results: At 24 weeks, significantly more spironolactone patients

achieved ACR20, ACR50 and ACR70 versus placebo. Significant

improvements in secondary measures DAS28, SDAI and HAQ-DI

were evident with spironolactone versus placebo. At 24weeks,

TNF-a, IL-6 and IL-1 improved significantly in SPIR compared with

placebo. After treatment with spironolactone; FMD, EPC and CIMT

significantly improved compared with placebo.

Conclusion: Spironolactone is effective in the treatment of RA and

significantly reduces inflammatory biomarkers, disease severity

and improves physical function. It also improves endothelial

dysfunction, EPC population and CIMT indicating its beneficial

effects on the enhanced cardiovascular risk of RA.

P43. Anticytokine, antioxidant and anti-inflammatory actionof spironolactone in collagen induced arthritis: Candidature ofspironolactone as a novel DMARD

Inderjeet Vermaa, Pawan Krishana, Ashit Syngleb; aDepartment ofPharmaceutical Sciences and Drug Research, Punjabi University,Patiala, India; bCardio Rheuma & Healing Touch City Clinic, FortisMulti Specialty Hospital, Mohali, India

Introduction: RA is an autoimmune and chronic inflammatory

condition with evolving treatment strategies. Cytokines may an

important role in the pathogenesis of RA and over expression of

cytokines have been demonstrated in rheumatic diseases. An

inhibitory effect proinflammatory cytokines production has been

reported to spironolactone.

Aim: To investigate the effect of spironolactone on the inflam-

matory response with collagen induced arthritis (CIA).

Methods: Immunizationwith type II collagen (CII) induces arthritis

inmice of theDBA/1 strain. SPIR (20mg, 40mg and 80mg/kg/day or

vehicle (0.5% CMC) and methotrexate (MTX) (5 mg/kg/week) or

vehicle PBSwas administered beginning on day 21 (arthritis onset)

until day 42 to different groups of studymice. Clinical, biochemical

estimation of TNF-a, IL-6, oxidativemarkers and histopathological

score were performed at the end of the study.

Results: Spironolactone treatment ameliorated the clinical signs

and improved the histologic findings in the joint and paw. The de-

gree of oxidative and nitric oxide damagewas significantly reduced

in spironolactone-treated mice, as indicated by elevation of SOD,

GSH, nitrite level and reduced TBARS levels after treatment with

spironolactone.Levelsoftheproinflammatorycytokines,TNF-aand

IL-6, were also significantly reduced by spironolactone treatment

and its effect was found to be comparable to that of methotrexate.

Conclusions: First experimental study to demonstrate that spi-

ronolactone exerts an anti-inflammatory and anti-cytokine effect

on chronic inflammation and is able to ameliorate the tissue

damage associated with CIA. Thus SPIR may have a disease

modifying role in RA.

P44. Utility of magnetic resonance imaging (MRI) as adiscriminating tool in early and un-differentiated rheumatoidarthritis

B.D. Pandey, J. Shukla; Department of Rheumatology, Fortis Hospital,Noida, India

Introduction: MRI is a very sensitive tool in detecting syno-

vitis, tenosynovitis, bone marrow edema and erosions.

However, this feature can't be clinically made out. The

American College of Rheumatology e European League

against Rheumatism (ACR-EULAR) task force emphasizes

early detection of RA and aggressive treatment to target as

objective goal in early Arthritis. We performed a prospective

observation study to determine the relationship between

clinical diagnosis of early and undifferentiated RA patients

and MRI features.

Methods: A total of 37/42 patients [15(40.54%) males) and

22(59.46%) females] visiting Rheumatology department with un-

differentiated Arthritis who underwent 1.5 extremity MRI of wrist

and metacarpophalangeal joints were included, 5 patients with

established RAwere excluded from the study. Scoring of synovitis,

bone marrow edema, bone erosions were done according to RA-

MRI (RAMRIS) scoring System.

Results: MRI findings of 3/37 patients observed high scores for

synovitis, edema and erosions were both Rheumatoid Factor(RF)

and anti-CCP negative and among them only one patient had

raised ESR and CRP. Only 2/14 patient with high synovitis score

were positive for RF and anti-CCP with ESR and CRP raised. 3/6

patients with high Bone Marrow Edema (BME) score were negative

for RF and Anti-CCP but had raised ESR and CRP.2/11 patients with

raised erosion score were positive for RF and Anti-CCP and had

raised ESR and CRP.

Conclusions: Patients had variable MRI inflammation results

when correlated clinically in early and undifferentiated arthritis,

the severity of MRI inflammation assessed according to RAMRIS

does not accurately differentiate patients with RA from other

early arthritis patients.

P45. Anemia in RA e Etiology and treatment outcomes

K. Chanakya, Vineeta Shobha; Immunology Division, Department ofMedicine, St Johns Medical College Hospital, Bangalore, India

Introduction: Anemia in Rheumatoid arthritis is a well-known

extra articular manifestation. Studies have shown that anemia of

chronic disease(ACD) is the most common cause of anemia in

patients with rheumatoid arthritis, and if detected early and

treated, results in better quality of life.

Aims And objectives: To find the etiology of anemia in patients

with RA, to find if severity of anemia and disease activity correlate,

and also to follow up the patients after 1 year to assess the disease

activity score (DAS) and Hb.

Methods: 50 consecutive patients of RA with moderate (Hb 9.5-

8.0gm) to severe (Hb<8.0gm) anemia were evaluated for

various causes of anemia. DAS was calculated using DAS28

calculator. After 1 year, patients were re-evaluated for DAS

and Hb.

Results: It was found that ACDwas themost common cause in the

study group occurring in 56% of patients followed by iron defi-

ciency anemia(IDA) in 20% of patients. Severity of anemia did not

correlate with disease activity. Longer duration of NSAID use,

higher visual analogue scale (VAS) for pain were associated with

severe anemia and, high ESR, high ferritin were associated with

ACD. 15 patients were naive to DMARDs at the beginning of the

study. Follow up Hb after 1 year of (n¼40) treatment with DMARDs

and iron supplements showed significant improvement in

hemoglobin.

Conclusions: Anemia in RA patients is most commonly due to

chronic inflammation. It is to be recognized promptly and trea-

ted.