Op78. Stress Signal Transduction Pathways Activated in Epidermal Keratinocytes in Systemic Sclerosis

severity of RP and improvement in scleroderma health assessment questionnaire (SSc HAQ). Endothelial function was assessed by measuring the flow mediated dilatation and soluble markers of endothelial function. Results: Twenty four of 25 recruited patients completed the study. There were 20 females. The mean age was 36.71 8.43 years and mean disease duration was 6.7 4.3 years. All the patients were receiving calcium channel blockers and 18 in addition were receiving other vasodilators. During Tadalafil therapy significant improvement in mean daily frequency of RP (2.23 1.43 versus 3.36 1.87, P<0.001), mean daily duration of RP (31.5 38.6 minute versus 53.9 55.5 minute, P1⁄40.015) and mean daily RCS (3.7 2.2 versus 5.1 2.5, P<0.001) were observed. All the 24 finger tip ulcers healed during tadalafil treatment as compared to three out of 13 finger tip ulcers during the placebo treatment (p<0.0001). One new finger tip ulcer was reported during tadalafil therapy as compared to 13 during placebo therapy (p1⁄4 0.0005). Patient and physician global assessment (p<0.001) and impact of RP and finger tip ulcers on activities of daily living assessed by SSc HAQ (P<0.001) improved significantly. Flow mediated dilatation, a surrogate marker of endothelial function, improved significantly while patients were on Tadalafil. There was no reduction in the levels of soluble markers of endothelial function, Endothelin-1 and PSelectin. One patient withdrew from study due to persistent erection with the first dose of tadalafil. No serious adverse event was observed during the study. Conclusions: Tadalafil as add on therapy is effective and well tolerated in the treatment of resistant secondary RP. Disclosure: The authors have declared no conflicts of interest.