P.040 Prognosis in Arm and Leg Tremor Onset Parkinson Disease

Background: There is no biological marker of progression in early Parkinson Disease (PD). Upper limb (UL) tremor is the most common motor symptom at onset. The significance of lower limb (LL) tremor remains unknown. We report on longitudinally followed autopsy-verified PD tremor onset cases. Methods: A chart review of longitudinally followed autopsy-verified PD cases was performed. Age and mode of onset were recorded at initial evaluation. Prognosis was measured by change in Hoehn and Yahr scale while on levodopa (LD). Results: Fourty-nine patients were included. Thirty-eight cases had upper limb (UL), four lower limb (LL), and seven upper and lower limb (ULL) onset tremor. UL had 86.8% response to LD, LL 50% and ULL 85.7%. Sub-analysis of UL responders found 20% mild improvement, 53.3% moderate and 26.7% marked. ULL had moderate response in 83.3% and marked in 16.7%. LL responders only had mild improvement with LD. Conclusions: Tremor onset is most common in UL, followed by ULL and then LL. LL onset tremor cases have an inferior response to LD when compared to UL and ULL cases.

Fractional erbium-YAG laser vs platelet rich plasma in acne scar: a comparative study

<p><strong>Background</strong>: Facial acne scar is a common complication of acne vulgaris leading to social isolation, lack of self-confidence and depression that warrants multiple treatment approach. In recent years, fractional erbium-yttrium aluminum garnet (er-YAG) 2940 nm laser and platelet-rich plasma (PRP) have been used independently or in combination with other resurfacing modalities in treating acne scars with variable outcomes. The objective of this study is to compare the therapeutic responses and safety of fractional erbium-YAG 2940 nm laser and platelet-rich plasma in atrophic post acne scars.</p><p><strong>Methods</strong>: Patients were randomly divided into two groups (30 each), receiving six sittings of fractional er-YAG laser and PRP every month. Response was evaluated 4 weeks after each treatment session using Goodman and Baron qualitative acne scar grading system, photographic assessment by 2 blinded dermatologist and patients own satisfaction.</p><p><strong>Results</strong>: Both treatment modalities showed improvement of acne scars, but the improvement with fractional er-YAG laser (27% marked and 70% moderate response) treatment was higher in comparison to PRP (10% marked and 67% moderate response) in terms of acne scar grade severity (p=0.33). Similar results were obtained on photographic assessment (p=0.015 and 0.021), and patient’s own satisfaction (p=0.011), respectively. Pain and stinging score were lower in er-YAG group while down time for same was shorter in PRP.</p><p><strong>Conclusions</strong>: Both er-YAG laser and PRP showed significant improvement in atrophic acne scar while former showing slightly superior response with lesser adverse effects.</p>

A Comparative Clinical Study of Gokshuradi Guggulu with Anupanabheda in The Management of Vatarakta with special reference to Gout

Gout is condition in which person become immobile and inactive due to joint pains and swelling. Gout occurs, when urate crystal deposition of in the joints. Vatarakta is considered as a vata pradhana vyadhi and rakta dushti. Gokshuradi Guggulu is having vatahara and raktashodhak properties. Guduchi kwatha selected as anupana because of its Rasayana, Vatashamaka, Balya, vedana sthapana and Ama pachana properties will help to disrupt the Samprapti vighatana of vatarakta. The objectives of the study were to evaluate the effect of Gokshuradi Guggulu with Anupanabheda in the management of Vatarakta and to compare the result of both groups. This study was randomized, parallel comparative clinical trial of two groups each of 20 patients. From OPD of DBACH Mandigobindgarh; 40 patients of vatarakta taken which were randomly divided into two groups. Group A, 20 patients for 60 days received Gokshuradi Guggulu 1 gm. BD with lukewarm water and Group B,20 patients received Gokshuradi Guggulu 1gm BD with Guduchi Kwatha for 60 days. In Group A, among 20 patient’s 55% patients showed moderate response and 45% patients showed mild response. In Group B among 20 patients, 95 % patients showed moderate response and 5 % patients showed mild response. Both shows statistically highly significant results in both subjective and objective except erythema & discoloration. Treatment modality in Group B (i.e. Gokshuradi Guggulu with Guduchi Kwatha) is effective in comparison of treatment modality in Group A (i.e. Gokshuradi Guggulu with lukewarm water).

Efficacy of intralesional Purified Protein Derivative (PPD) in the treatment of multiple warts

Cutaneous warts are a common dermatological condition caused by the human papillomavirus (HPV) strains 1,2,4 and rarely 57. Although it is a benign condition, it causes disfigurement, pain, discomfort, has a tendency to koebnerize, and can be transmitted to others. This makes adequate and timely treatment important. There are several conventional treatments available which include electrosurgery, cryotherapy and topical medications like imiquimod which show variable responses. Our study evaluated the effectiveness and associated side effects of intralesional PPD for the treatment of multiple warts in a group of 20 patients. This is done as a form of immunotherapy. It was administered at a dosage of 0.1ml into each lesional site every two weeks until the clearance of lesions or up to a maximum of 6 injections. We observed a marked response in 5%, moderate response in 75% and no response in 20 % of our study population with no complications. On comparison to previous similar studies, the accuracy of our observed results for efficacy and observed side effects was reinforced. Hence proves to be a modality of treatment that should be more widely used for the treatment of warts as it is cheap, safe, less stressful and comparatively more effective.

A Comparison of Diagnostic Performance of Signal Intensity and Volume Related MRI Multiparameters for Assessing Different Response of Rectal Cancer to Neoadjuvant Chemoradiotherapy

Background: “Wait-and-see”, has been proposed as a possible method of treatment in patients with locally advanced rectal cancer (LARC) after chemoradiotherapy (CRT), MR is important to predict the pathological tumor regression grade(TRG) to preoperative CRT. This study aims to evaluate the diagnostic value of signal intensity (SI) and volume (V) change rate in magnetic resonance imaging (MR) and determine which ones perform best as a potential biomarker for predicting pathological TRG to preoperative CRT in patients with LARC.Methods: A retrospective analysis of 82 patients with LARC, for whom clinical and imaging data were retrieved from our institute was conducted between Oct 2017and Oct 2019. Patients underwent pre- and post-CRT T2-weighted (T2W), diffusion-weighted (DW)/apparent diffusion coefficient (ADC) and contrast-enhanced T1-weighted (ceT1W). V, difference of volume between pre-CRT and post-CRT tumor (△V), V of tumor reduction rate (%△V), as well as SI of tumor (SIt), SI of muscle (SIm), relative SI ratio of tumor/muscle (SIR), changed difference SIR between pre- and post-CRT SIR (△SIR), SIR of tumor changed rate (%△SIR) on T2W, ADC and ceT1W were measured. All of LARC after CRT were confirmed pathologically and classifed into histologic TRG: TRG 0 (complete response), TRG 1 (moderate response), TRG 2 (minimal response), TRG 3 (poor response). Descriptive statistics and areas under the receiver operating characteristic curves (ROC) were generated to compare performance of %△V and %△SIR on T2W, DW, ceT1W for distinguishing between different pathological TRG.Result: Of the 82 patients, TRG 0 (16), TRG 1 (15), TRG 2 (35), TRG 3 (16).Except for ADC-%△SIR, the remaining %△V and %△SIR on T1W, ADC/DWI, ceT1W showed statistics significance between four groups. There was not distinguishable between TRG 1 and TRG 2, TRG 2 and TRG 3 by %△V and/ or %△SIR, the remaining different TRG all were identified by %△V and/ or %△SIR on T2W, ADC/DWI, ceT1W. Compared with other individual %△V or %△SIR, the combination of DW-%△V and T2W-%△SIR (DW-%△V * T2W-%△SIR) yielded higher AUCs to predict TRG 0 from TRG 2 (AUCs: 0.954, sensitivity: 93.75%, specificity: 97.14%) and TRG 3 (AUCs: 1.000, sensitivity: 100%, specificity: 100%), although AUC of all had not significant differences between TRG groups. there was statistically significant differences in post-CRT T restage and ypT stage between fours groups, respectively, but the agreement between post-CRT T restage and ypT is low ( kappa=0.191).Conclusions: V and/or SIR change rate on T2W, DW, ceT1W with high diagnostic performance could be useful in differentiating complete response from non-complete response; SIR change rate could be useful for distinguishing between moderate response and poor response.

Does autoimmune thyroid disease affects rheumatoid arthritis disease activity or response to methotrexate?

ObjectiveTo investigate if autoimmune thyroid disease (AITD) impacts rheumatoid arthritis (RA) disease activity or response to methotrexate.MethodsA nationwide register-based cohort study of 9 004 patients with new-onset RA from the Swedish Rheumatology Quality Register year 2006–2016, with linkage to other nationwide registers to identify comorbidity with AITD defined as thyroxine prescription before RA diagnosis, excluding non-autoimmune causes. We compared RA disease activity using 28-joint Disease Activity Score (DAS28) and its components, and EULAR response, between patients with and without AITD, using logistic regression.ResultsAt diagnosis, patient reported outcome measures (PROMs; patient global, Health Assessment Questionnaire Disability Index and pain) but not objective disease activity measures (erythrocyte sedimentation rate and swollen joint count) were significantly higher (p<0.05 for all PROMs) among RA patients with AITD compared with those without. The level of DAS28 was 5.2 vs 5.1. By contrast, AITD had little influence on EULAR response to methotrexate at 3 months (OR of non/moderate response=0.95, 95% CI 0.8 to 1.1), nor at 6 months. When stratified by age, however, AITD was more common among EULAR non/moderate responders at 3 and 6 months in patients below 45 years resulting in ORs of non/moderate response of 1.44 (0.76–2.76) and 2.75 (1.04–7.28).ConclusionAt diagnosis, RA patients with concomitant AITD score worse on patient reported but not on objective RA disease activity measures, while DAS28 was only marginally elevated. The overall chance of achieving a EULAR good response at 3 or 6 months remains unaffected, although among a limited subgroup of younger patients, AITD may be a predictor for an inferior primary response.

FRI0062 THE USE OF A COMORBIDITY INDEX FOR PREDICTING CLINICAL RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING THEIR FIRST BIOLOGICAL AGENT

Background:Several studies in Rheumatoid arthritis (RA) have suggested that a greater number of comorbidities is associated with worse functional status and disease activity measures. However, it is useful to use a composite comorbidity index, such as Rheumatic Disease Comorbidity Index (RDCI) that is validated for the use in patients with rheumatic diseases, to better understand the overall role of comorbidities in treatment outcomes.Objectives:To evaluate the impact of comorbidities on 12-month clinical response in a cohort of patients with RA treated with a first-line biologic disease-modifying antirheumatic drug (bDMARD), by using the RDCI.Methods:Observational retrospective study was performed including consecutive patients with the diagnosis of RA followed at our Rheumatology Department. The prevalence of comorbidities was computed, and patients were stratified according to RDCI for evaluating its role in clinical response disease activity at baseline and follow up (6 and 12 months). Correlations between variables were studied using Spearman correlation analysis, comparison between groups was performed using Kruskal-Wallis and Chi-square. A multivariate logistic regression model was developed to examine the role of RDCI along with other baseline factors as potential predictor of achieving remission, low disease activity (LDA), and EULAR good/moderate response. Statistical analyses were performed using SPSS statistical software, version 23.0.Results:A total of 251 patients were included: 83.7% (n=210) females, mean age of 58 (± 11.10) years old, with a median disease duration of 16.11 years [10.79 - 23.04]. The majority exhibited a very high or high disease activity at baseline (median DAS28 3V 5.48 [4.70 – 6.19]) and 90% (n=226) of them were concomitantly using corticosteroids and/or other disease-modifying anti-rheumatic drugs (129 with methotrexate (MTX), 96 with leflunomide and 35 with sulfasalazine). The most frequently reported comorbidities were cardiovascular disorders (37.5%), osteoporosis (7.6%) and depression (6.8%). The median RDCI score was 1.0 [0.0 – 2.0] and the majority of patients (63.6%) carried at least one comorbidity. When comparing baseline demographic and clinical characteristics of the 4 subgroups, stratified according to RDCI score (RDCI=0, 1, 2, or ≥3), we found statistically significant differences in age, age at diagnosis, sex and the prescribed anti-TNF agent (p<0.05). There was a progressive increase in the mean age as the RDCI score increased between the subgroups.RDCI strongly correlates with the number of comorbidities (NC) (r=0.764, p<0.01). NC was weakly correlated with patient and physician global assessment of disease activity (pVAS and phVAS) (r=0.183, p<0.01 and r=0.196, p=0.019, respectively), DAS28 3V (r=0.192, p=0.046) and HAQ-DI (r=0.301, p<0.01) at 6 months. Moreover, RDCI poorly correlated with CRP (r=0.192, p=0.01), pVAS (r=0.183, p=0.02) and HAQ-DI (r=0.202, p<0.01). Weaker correlations were also found at 12 months: NC with pVAS (r= 0.196, p=0.02), DAS28 3V (r=0.216, p=0.01) and HAQ-DI (r=0.187, p=0.04); RDCI with phVAS (r= 0.196, p=0.04).The 12-month DAS28 remission rate was 37.8% (n=95); 6.7% (n=17) achieved EULAR good response and 54.4% (n=137) a moderate EULAR response. RDCI was not an independent predictor of DAS remission (OR 0.794, 95% CI 0.561- 1.125,p =0.194) nor it was of EULAR good/moderate response (OR 0,720, 95% CI 0.430- 1.206, p= 0.212).Conclusion:Although our data point to a weak association between morbidities, assessed by the RDCI, and response to a first bDMARD, it is important to consider this simple and useful tool in future prospective and broader studies, since information bias regarding comorbidities may have been responsible for our results.Disclosure of Interests:Salomé Garcia: None declared, Bruno Miguel Fernandes: None declared, Georgina Terroso: None declared, Miguel Bernardes Speakers bureau: Abbvie, Amgen, Biogen, Eli-Lilly, Glaxo-Smith-Kline, Pfizer, Janssen, Novartis, Lúcia Costa: None declared