POS0311 FLARES IN PATIENTS WITH RECENT-ONSET PSORIATIC ARTHRITIS. PREDICTIVE MODEL BASED ON MACHINE LEARNING

Background

An important aspect in the clinical care of patients with PsA is to be able to predict the occurrence of a flare using tools and information that are readily available in daily clinical practice. This information would provide added value in disease management, yet, unfortunately, scarcely any studies provide it.

Objectives

To identify patient- and disease-related characteristics that make it possible to predict flares in recent-onset PsA.

Methods

We performed a multicenter observational prospective study (2-year follow-up, regular annual visits), promoted by the Spanish Society of Rheumatology [1]. The study population comprised patients aged ≥18 years who fulfilled the CASPAR criteria [2], with less than 2 years since the onset of symptoms. The intention at the baseline visit was to reflect the patient’s situation before disease progress was modified by the treatments prescribed in the rheumatology department.

All patients gave their informed consent. The study was approved by the Clinical Research Ethics Committee of the Principality of Asturias.

Flares were defined as inflammatory episodes affecting the axial skeleton and/or peripheral joints (joints, digits or entheses) and diagnosed by a rheumatologist between the previous and the current visit.

The dataset contained data for the independent variables from the baseline visit and from follow-up visit number 1. These were matched with the outcome measures from follow-up visits 1 and 2, respectively. We trained logistic regression models and a random forest–type machine learning algorithm to analyze the association between the outcome measure and the variables selected in the bivariate analysis (statistical significance was defined as p value <0.05). We used a confusion matrix to visualize the performance of the final model. This matrix shows the real class of the data items, together with the class predicted by the machine learning algorithm, and records the number of hits and misses.

Results

The sample comprised 158 patients. 14.6% were lost to follow-up. At the first follow-up visit, 37.6% of the patients who attended the clinic had experienced flares since the baseline visit. Of those who attended the second visit, 27.4% had experienced flares since the first visit. Table 1 shows the results of the logistic regression analysis. The variables predicting flares between visits selected in this analysis were age-adjusted Charlson comorbidity index, PsAID score, number of digits with onychopathy, and level of physical activity. The direction of the association was negative for the Charlson index and physical activity and positive for PsAID score and onychopathy.

Table 1.

Variables associated with flares between visits selected in the logistic regression analysis.

VariableRegression coefficient95% CIp value (Wald test)Age-adjusted Charlson comorbidity Index-4.655(-7.021, -2.289)<0.001PsAID score2.212(1.171, 3.254)<0.001No. of digits with onychopathy1.420(0.331, 2.511)0.011Level of physical activity-1.221(-1.87, -0.572)<0.001

When the random forest machine learning algorithm was trained with these 4 variables, the order of importance (from more to less) attributed by the model was as follows: PsAID score, number of digits with onychopathy, age-adjusted Charlson comorbidity index, and level of physical activity. The percentage of hits in the confusion matrix was 78.38%.

Conclusion

PsAID score was the first variable in the predictive hierarchy generated in our model, supporting its importance in the management and follow-up of PsA patients.

References

[1]Queiro R, Laiz A, Seoane-Mato D, Galindez Agirregoikoa E, Montilla C, Park HS, et al. Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology. Reumatol Clin (Engl Ed) 2019;15:252-7.

[2]Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54:2665-73.

Acknowledgements

The authors would like to acknowledge José Luis Fernández Sueiro for the conception of the study; José Miguel Carrasco for his contribution to the design of the study; Nuria Montero and Cristina Oliva for her contribution to data monitoring; Ana Serrano and Cristina Pruenza for her contribution to data analysis; Thomas O´Boyle for the translation; and non-author investigators of Proyecto REAPSER Study Group.

Disclosure of Interests

None declared

AB0931 Characteristics associated with the perception of high-impact disease (PsAID ≥4) in patients with recent-onset psoriatic arthritis. Model based on machine learning

Background

The Psoriatic Arthritis Impact of Disease (PsAID) questionnaire is the standard tool for evaluating the impact of psoriatic arthritis (PsA) on quality of life [1]. Variables associated with high disease impact were studied in patients with long-standing established disease. The characteristics associated with high-impact PsAID in recent-onset PsA remain unknown.

Objectives

To evaluate which patient and disease characteristics are associated with the perception of high-impact disease (PsAID ≥4) in recent-onset PsA.

All patients gave their informed consent. The study was approved by the Clinical Research Ethics Committee of the Principality of Asturias.

We conducted a cross-sectional analysis. The dataset was generated using data for the independent variables at the 3 visits (baseline, first year, and second year of follow-up) matched with the PsAID values at each of the 3 visits. PsAID was categorized into two groups, namely, <4 and ≥4 [1]. We trained logistic regression models and a random forest–type machine learning algorithm to analyze the association between the outcome measure and the variables selected in the bivariate analysis (statistical significance defined as p value <0.05). We used a confusion matrix to visualize the performance of the final model. This matrix shows the real class of the data items, together with the class predicted by the machine learning algorithm, and records the number of hits and misses.

Results

The sample comprised 158 patients. 20.9% were lost to follow-up. Of the patients who attended the clinic, 45.8% scored PsAID ≥4 at baseline; 27.1%, at the first follow-up visit, and 23.0%, at the second follow-up visit. The variables associated with PsAID ≥4 selected in the logistic regression analysis were HAQ, patient global pain during the previous week, educational level, and level of physical activity in the previous week. The association was positive for the first 2 variables and for level of physical activity and negative for educational level. When physical activity was introduced as a categorical variable, a possible negative association was observed for a moderate level (although this was not statistically significant) and a positive association was observed for a high level (Table 1).

Table 1.

Variables associated with PsAID ≥4: Logistic regression analysis.

VariableRegression coefficient95% CIp value (Wald test)HAQ10.394[7.777, 13.011]<0.001Patient global pain in the previous week5.668[4.016, 7.320]<0.001Educational level-2.064[-3.515, -0.613]0.005Moderate level of physical activity in the previous week-0.341[-1.255, 0.573]0.465High level of physical activity in the previous week1.221[0.158, 2.283]0.024

When the random forest–type machine learning algorithm was trained with these 4 variables, the order of importance (from more to less) attributed by the model was: patient global pain, HAQ, educational level, and physical activity. The percentage of hits in the confusion matrix was 86.14%.

Conclusion

Pain control and control of the disease as a whole, preventing patients from suffering a decrease in their functional capacity, are first-order treatment objectives. PsA patients should take regular physical exercise, but with a moderate or low impact on their joints and entheses.

References

[1]Orbai A, Holland R, Leung YY, Tillett W, Goel N, McHugh N et al. PsAID12 provisionally endorsed at OMERACT 2018 as core outcome measure to assess psoriatic arthritis-specific health- related quality of life in clinical trials. J Rheumatol 2019;46:990–95.

Acknowledgements

The authors would like to acknowledge José Luis Fernández Sueiro for his contribution to the conception of the study; José Miguel Carrasco for his contribution to the design of the study; Nuria Montero and Cristina Oliva for her contribution to data monitoring; Ana González Marcos and Cristina Pruenza for her contribution to data analysis; Thomas O´Boyle for the translation of the manuscript; and non-author investigators of Proyecto REAPSER Study Group

Disclosure of Interests

None declared

AB0868 PREVALENCE AND RISK FOR BUNDLE BRANCH BLOCK, ATRIOVENTRICULAR BLOCK AND PACEMAKER IMPLANTATION IN SPONDYLOARTHRITIS. A SYSTEMATIC REVIEW OF THE LITERATURE

Background

Inflammation of the valve attachment site may produce tissue degeneration near the atrioventricular node, which may lead to electrical conduction disturbances, that is to say atrioventricular block (AVB) and bundle branch block (BBB).

Objectives

To evaluate the evidence regarding the prevalence and risk of BB, AVB and pacemaker implantation (PMI) in patients with spondyloarthritis (SpA) compared to a control group without SpA.

Methods

A systematic review of the literature was performed using Pubmed (Medline), EMBASE (Elsevier) and Cochrane Library (Wiley) databases until December 2021. The risk for AVB, BBB and PMI were analyzed. Cohort, case control and cross-sectional studies in patients ≥18 years meeting the classification criteria for SpA were included. The Odds ratio (OR), risk ratio (RR) or Hazard ratio (HR) were considered as outcomes. Data was synthesized in a previously defined extraction form. The risk of bias was assessed by the Newcastle-Ottawa Scale.

Results

In total, eight out of 374 studies were included. As for low grade AVB and BBB, only indirect results comparing prevalences from low to medium quality studies were found. According to population based registries, the sex and age adjusted HR of AVB was 2.3 (95% CI 1.6 - 3.3) in ankylosing spondylitis, 2.9 (95% CI 1.8 - 4.7) in undifferentiated spondyloarthritis and 1.5 (95% CI 1.1 a 1.9) in psoriatic arthritis. The RR for PMI was 1.3 (95% CI 1.16 - 1.46) for groups aged between 65-69 years, 1.33 (95% CI 1.22 - 1.44) for 70-75 years, 1.24 (95% CI 1.55 - 1.33) for 75-79 years and 1.11 (95% CI 1.06 - 1.17) for groups older than 80 years.

AuthorStudy designPopulationSample numberTestOutcomesAdjustmentBaniaamam 2021[6]Cross sectionalAS and osteoarthritis between 50-75 years267ECGPrevalence of AVB, BBB and PMIControls matched for age, sex and smoking statusBengtsson 2017[12]CohortAS, uSpA, PsA, GPfrom the Swedish national registry294136ICD-10Prevalence, Incidence, HR, for AVB and PMI compared to GPAge, sexDik 2010[9]Cross sectionalAS131ECGPrevalence of AVB and BBB Association of PR interval with AS disease related variablesAge, sex, disease durationFeld 2008[10]Case controlPsA compared to non psoriatic nor arthritic patients184ECGPrevalence of AVB, BBB Correlation of PR interval with AS disease related variablesNoneFu 2016[8]Cross sectionalAS between 18-50y without cardiac disease122ECGPrevalence of AVB, BBB AS without kyphosisNoneGoulenok 2010[13]Cross sectionalSpA, RA and control group without known CV disease288ECGPrevalence AVB, BBNoneWard 2018[7]CohortAS from Medicare database older than 6542,327ICD-9Prevalence, incidence, OR of PMIAge, sex, raceYildrir 1999[11]Case controlAS88Holter and ECGPrevalence of AVBNone

Conclusion

The differences of prevalence in AVB and BBB were similar in SpA and control groups even though studies lacked the power. According to population registries there was an two fold-increased risk of high grade AVB in SpA patients. RR for PMI was higher in younger age groups.

Disclosure of Interests

Hye Sang Park: None declared, Ana Laiz Speakers bureau: A.L. has received speaker fees/honoraria from Abbvie, Lilly, Novartis, Pfizer and UCB, Petra Díaz del Campo Fontecha: None declared, Mª Auxiliadora Martín Martínez: None declared, Mercedes Guerra-Rodriguez: None declared, Concepción Alonso Martín: None declared, Jesus Sanchez-Vega: None declared, Hector Corominas Speakers bureau: H.C. has received speaker fees/honoraria from BMS, Gebro, MSD, Lilly, Novartis, Pfizer, Roche, Sanofi, and UCB, Consultant of: H.C. has participated in consulting for Abbvie, Amgen, Biogen, Celgene, Gilead, Kern, Pfizer and Sanofi.

POS1074 MINIMAL DISEASE ACTIVITY (MDA) IN PATIENTS WITH RECENT-ONSET PSORIATIC ARTHRITIS. PREDICTIVE MODEL BASED ON MACHINE LEARNING

Background

Very few data are available on predictors of minimal disease activity (MDA) in patients with recent-onset psoriatic arthritis (PsA). Such data are crucial, since the therapeutic measures used to change the adverse course of PsA are more likely to succeed if we intervene early.

Objectives

To detect patient and disease variables associated with achieving MDA in patients with recent-onset PsA.

Methods

We performed a multicenter observational prospective study (2-year follow-up, regular annual visits), promoted by the Spanish Society of Rheumatology. Patients aged ≥18 years who fulfilled the CASPAR criteria, with less than 2 years since the onset of symptoms, were included. The intention at the baseline visit was to reflect the patient’s situation before disease progress was modified by the treatments prescribed by the rheumatologist.

All patients gave their informed consent. The study was approved by the Clinical Research Ethics Committee of the Principality of Asturias.

MDA was defined as fulfillment of at least 5 of the following: ≤1 tender joint; ≤1 swollen joint; PASI ≤1 or BSA ≤3%; score on the visual analog scale (VAS) for pain provided by the patient ≤1.5; overall score for disease activity provided by the patient ≤2; HAQ score ≤0.5; ≤1 painful enthesis [1].

The dataset contained data for the independent variables from the baseline visit and from follow-up visit number 1. These were matched with the outcome measures from follow-up visits 1 and 2, respectively. We trained a random forest–type machine learning algorithm to analyze the association between the outcome measure and the variables selected in the bivariate analysis. In order to understand how the model uses the variables to make its predictions, we applied the SHAP technique. This approach assigns a SHAP value to each value of each variable according to the extent to which it affects the prediction of the model (the higher the absolute SHAP value, the greater the influence of this data item on prediction) and to how it affects the prediction (if the SHAP value is positive, the data item positively affects the prediction, that is, it confers a higher value on the prediction). The SHAP summary graphs order the predictors by their importance in the predictions of the model. This importance is calculated with the mean of the SHAP values assigned to each data item of a variable; mean values <0.01 indicate the low importance of the variable in the model. We used a confusion matrix to visualize the performance of the model. This matrix shows the real class of the data items, together with the predicted class, and records the number of hits and misses.

Results

The sample comprised 158 patients. 14.6% were lost to follow-up. 55.5% and 58.3% of the patients had MDA at the first and second follow-up visit, respectively. The importance of the variables in the model according to the mean of the SHAP values is shown in Table 1. The variables with the greatest predictive ability were global pain, impact of the disease (PsAID), patient global assessment of disease and physical function (HAQ-Disability Index). The SHAP values for each value of each variable are shown in Figure 1. The percentage of hits in the confusion matrix was 85.94%.

Table 1.

Variables in the predictions of the random forest for MDA according to the SHAP method.

VariableImportance according to SHAP1Global pain0.069PsAID0.064Patient global assessment of disease0.047HAQ0.044Articular pattern at diagnosis0.029Physician global assessment of disease0.023Tender joint count0.014Sex0.009Weekly alcohol consumption0.009

1Mean of the SHAP values for each value of the variable.

MDA: minimal disease activity.

Figure 1.

SHAP summary graph.

Conclusion

A key objective in the management of PsA should be control of pain, which is not always associated with inflammatory burden, and the establishment of measures to better control the various domains of PsA.

References

[1]Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis. 2010;69:48-53.

Acknowledgements

The authors would like to acknowledge José Luis Fernández Sueiro for the conception of the study; José Miguel Carrasco for his contribution to the design of the study; Nuria Montero and Cristina Oliva for her contribution to data monitoring; Ana González Marcos and Cristina Pruenza for her contribution to data analysis; and Thomas O´Boyle for the translation of the manuscript.

Disclosure of Interests

None declared

AB0804 ONE YEAR FOLLOW-UP SAFETY AND EFFICACY RESULTS OF VACCINATION PROTOCOL FROM A RHEUMATOLOGY CLINIC

Background:

Patients with autoimmune inflammatory rheumatic diseases (AIIRD) have a higher burden of infectious diseases compared to the general population. This could be explained by the disturbances in their immune system response, comorbidities and immunosuppressive treatment.Vaccination is the most effective measure to prevent infections.

Objectives:

To describe a cohort of patients with AIIRD referred to the infectious disease´s unit according to the vaccination protocol.

Methods:

Restrospective and descriptive study of a cohort of 286 patients with AIIRD who were evaluated in the rheumatology service of a tertiary hospital in Barcelona and referred to the infectious disease´s unit according to the vaccination protocol among 1 year,between January 1rst December 31st, 2019. The vaccination protocol included serologies of human immunodeficiency virus,hepatitis A,B and C, varicella zoster,tuberculosis,measles,mumps and rubella virus.The recommended vaccines were H.influenzae b,S.pneumonia,influenza,hepatitis A and B(immunity absence),meningococcus c,tetanus – diphtheria (low antigenic load),poliomyelitis and human papillomavirus (not vaccinated).The patients included were diagnosed with a rheumatologic condition under immunosuppressive therapy. Demographic variables,diagnosis,treatment,vaccines administered,infections and adverse effects were collected.

Results:

Of 286 patients reviewed the mean age was 61, 4 (±14.4) years. The characteristics of the cohort are shown in Table 1. Most of the patients used csDMARDs 149 (52.1%), 77(26.9%) patients used combined treatment. Measles and rubella are part of the triple virus vaccines included in the systematic Spanish vaccination schedule, in our cohort 20 (7%) patients had negative serologies for measles and 26 (9%) for rubella. 57 (20%) patients had latent TB with positive Quantiferon.Forty-one (14.3%) were vaccinated before receiving immunosuppressive treatment. The less administered vaccine was influenza with 44.9% (vaccination rate in Spain in healthy population, in 2019-2020 was 51.2%).No serious adverse effects were reported in relation to the vaccination. The infectious complications during the follow-up period were bronchopneumonia in a patient with RA treated with certolizumab (1), herpes zoster infection in RA on adalimumab(1), recurrent otitis in RA on adalimumab(1), mycobacterium avium infection in RA on etanercept(1), TB reactivation in RA with GCs and csDMARDs(1) and Papilloma virus infection in SpA on ustekinumab (1).

Table 1.

CHARACTERISTICS OF COHORT OF PATIENTS

Sex n % (women/men)193/93 (67,5/32,5)Age, years ± DE61.4 ± 14.4Diagnoses AIIRD, n (%)Rheumatoid arthritis n (%)164 (57.3)Systemic lupus erythematosus n (%)6 (2.1)Sjögren´s syndrome n (%)9 (3.1)Systemic sclerosis n (%)1 (0.35)Inflammatory myopathie n (%)5 (1.7)Vasculitis n (%)36 (12.6)Polymyalgia rheumatica n (%)4 (1.4)Spondyloarthropathy n (%)46 (16.1)Others n (%)15 (5.2)Treatment AIIRDGCs n (%)116 (40.7)csDMARDs n (%)149 (52.1)bDMARDs n (%)80 (27.8)tsDMARDs n (%)7 (2.4)Others1 n (%)12 (4.2)GCs + csDMARDs n (%)59 (21)GCs + bDMARDs n (%)14 (4.9)GCs + csDMARDs + bDMARDs n (%)4 (1.4)VaccinesPCV 13 n (%)283 (99)PPSV23 n (%)265 (93)HiB n (%)265 (93)NM n (%)247 (86.7)Influenza n (%)128 (44.9)HBV n (%)121 (42.3)Vaccination before IS n (%)41 (14.3)Vaccination with IS n (%)244 (85.3)

Other: Behcet,Adult Stills,Relapsing polychondritis,IGg4 related disease,Sarcoidosis

Others1: Mycophenolic acid,cyclosporine and tacrolimus

Conclusion:

In our cohort, the vaccination protocol proved to be a good tool to improve the vaccination rate of rheumatological patients, despite this, the vaccination of Hepatitis B and specially of influenza, continues to have a lower prevalence to general population.The vaccines were effective since none of the preventable infections occurred during follow up, despite the use of an immunosuppressant. Vaccination showed a good safety profile, without reported serious adverse effects or worsening of the underlying disease.

Disclosure of Interests:

None declared

AB0129 IL-6R GENETIC VARIANTS AS PREDICTORS OF CLINICAL RESPONSE TO TOCILIZUMAB IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease of unknown etiology. Tocilizumab (TCZ) is a first-line biological disease-modifying anti-rheumatic drug (bDMARD) which inhibits Interleukin 6 (IL-6) pathway through blockade of its receptor. At present, there is a lack of evidence to recommend the treatment of one bDMARD over another.(1) Seeking for genetic biomarkers to predict response to treatment could be key towards a personalized treatment strategy in rheumatology.(2)

Objectives:

We aimed to evaluate whether functional single nucleotide polymorphisms (SNPs) in the IL6R gene could predict response and/or toxicity to TZC in Caucasian patients diagnosed with RA.

Methods:

Retrospective analytical preliminar study of a cohort of 31 patients diagnosed with RA (ACR/EULAR 2010 criteria) who received treatment with TCZ within the last 10 years. Epidemiological, clinical and laboratory data were collected. DNA was extracted from EDTA blood samples. Three SNPs in the IL-6 receptor gene (rs12083537, rs2228145, rs4329505) were genotyped by real-time PCR with TaqMan probes. The associations between polymorphisms and clinicopathological features were evaluated using parametric tests. Efficacy was assessed as the difference of DAS-28 CRP at 6 months. The toxicities recorded were hepatotoxicity, infections, hypersensibility, gastrointestinal, hematological and dyslipidemia.

Results:

The 31 DNA samples from patients included were mainly female (83.9%) and had a mean age at diagnosis of 46.8 years. The mean duration of treatment was 51.3 months and, previously to initiate TCZ, they received a mean of 2,6 csDMARD and 1,7 bDMARD.

The more frequent adverse effects were hypertransaminasemia (22.6%) and neutropenia (32.3%). Most relevant epidemiologic and clinical data is shown in Table 1.

Table 1.

Clinical characteristics. RA=Rheumatoid Arthritis. CCP= anti-Cyclic Citrullinated Peptides. RF=Rheumatoid factor. csDMARDs= conventional synthetic Disease-modifying antirheumatic drug. bDMARD= biological Disease-modifying antirheumatic drug. BMI=Body Mass Index. Sc=subcutaneous. Ev=endovenous. DAS28= Disease Activity Score in 28 joints

Sex (n=31), n (% women/men) 26/5 (83,9%/16,1%)Age at diagnosis (n=31), years +- SD 46,8+- 12,8Erosive RA (n=31), n(%) 14 (45,2%)Anti-CCP positive (n=31), n(%)UI+- SD 23 (74,2%)259,7 +- 137,3RF positive (n=31), n (%)UI+-SD 21 (67,7%)189,4+- 114Previous csDMARD (n=31), n°+-SD2,6 +-1,3Previous bDMARD (n=31), n°+- SD1,7 +- 1,4BMI (n=29), mean +- SD29,3+- 5,1Duration of treatment (n=31), months +-SD51,3 +- 36,3-Active treatment (n=12)-80,9+- 18,3-Finished treatment (n=19)-32,6+- 32,2Route of administration (n=31), n (%) sc/ev 11/20 (35,5/64,5)Basal DAS28 (n=30), mean+- SD5,3 +- 1,1DAS28 reduction at 6 months (n=28), mean+-SD2,9 +-1,1

The univariate analyses showed that the rs2228145 variant was statistically associated with differences in DAS28 reduction at 6 months (p=0.042). Regarding efficacy, we also found a trend with the SNP rs4329505 (p=0.173), which could achieve statistical significance with the projected inclusion of more patients. No associations were found regarding adverse effects.

Conclusion:

The rs2228145 polymorphisms in the IL6R gene may be considered as a pharmacogenetic biomarker of TCZ response in RA patients. More studies are required in order to investigate the clinical use of pharmacogenetic biomarkers in rheumatic diseases.

References:

[1]Smolen, Josef S., Robert B., et al. 2020. “EULAR Recommendations for the Management of Rheumatoid Arthritis with Synthetic and Biological Disease-Modifying Antirheumatic Drugs: 2019 Update.” Annals of the Rheumatic Diseases 79 (6): 685–99.

[2]Tarnowski, Maciej, Agnieszka Paradowska-Gorycka, et al. 2016. “The Effect of Gene Polymorphisms on Patient Responses to Rheumatoid Arthritis Therapy.” Expert Opinion on Drug Metabolism & Toxicology 12 (1): 41–55.

Disclosure of Interests:

None declared

AB0666 PROGNOSTIC VALUE OF SERUM KREBS VON DEN LUNGEN-6 GLYCOPROTEIN CIRCULATING LEVELS IN COVID-19 PNEUMONIA: A PROSPECTIVE COHORT STUDY

Background:

Currently, there are no biomarkers to predict respiratory worsening in patients with Coronavirus infectious disease, 2019 (COVID- 19) pneumonia.

Objectives:

We aimed to determine the prognostic value of Krebs von de Lungen-6 circulating serum levels (sKL-6) predicting COVID- 19 evolving trends.

Methods:

We prospectively analyzed the clinical and laboratory characteristics of 375 COVID- 19 patients with mild lung disease on admission. sKL-6 was obtained in all patients at baseline and compared among patients with respiratory worsening.

Results:

45.1% of patients developed respiratory worsening during hospitalization. Baseline sKL-6 levels were higher in patients who had respiratory worsening (median [IQR] 303 [209-449] vs. 285.5 [15.8-5724], P=0.068). The best sKL-6 cut-off point was 408 U/mL (area under the curve 0.55; 33% sensitivity, 79% specificity). Independent predictors of respiratory worsening were sKL-6 serum levels, age >51 years, time hospitalized, and dyspnea on admission. Patients with baseline sKL-6 ≥ 408 U/mL had a 39% higher risk of developing respiratory aggravation seven days after admission. In patients with serial determinations, sKL-6 was also higher in those who subsequently worsened (median [IQR] 330 [219-460] vs 290.5 [193-396]; p<0.02).

Conclusion:

sKL-6 has a low sensibility to predict respiratory worsening in patients with mild COVID-19 pneumonia. Baseline sKL-6 ≥ 408 U/mL is associated to a higher risk of respiratory worsening. sKL-6 levels are not useful as a screening tool to stratify patients on admission but further research is needed to investigate if serial determinations of sKL-6 may be of prognostic use.

References:

[1]Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. 5.

[2]Tian W, Jiang W, Yao J, Nicholson CJ, Li RH, Sigurslid HH, et al. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Med Virol. 2020.

[3]Wang D, Li R, Wang J, Jiang Q, Gao C, Yang J, et al. Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: a descriptive study. BMC Infect Dis. 2020;20(1):519.

Disclosure of Interests:

None declared.

AB0770 DESCRIBING A COHORT OF PATIENTS WITH PSORIATIC ARTHRITIS ACCORDING TO THE BODY MASS INDEX: EXPERIENCE IN A JOINT RHEUMATOLOGY-DERMATOLOGY CLINIC

Background:

Obesity is a predictor for the development of psoriatic arthritis (PsA) with a negative prognostic impact.

Objectives:

We aimed to describe and characterize patients with PsA according to the Body Mass Index (BMI) in a joint Rheumatology-Dermatology unit (PAIDER).

Methods:

We retrospectively reviewed patients diagnosed with PsA according to CASPAR criteria visited between May 2012 and May 2019 at the PAIDER clinic of our center. Data on demographic and anthropometric features, serologic findings, source of referral, cardiovascular risk factors and biological treatment were collected from clinical records. Patients were classified according to the WHO International Classification of nutritional status in normal weight (BMI 18.5-24.9 Kg/m2), overweight (BMI 25-29.9 Kg/m2) and obesity (BMI≥30 Kg/m2). A descriptive analysis was performed, and the differences between groups were evaluated using Chi2, T-Student and ANOVA tests. P-values <0.05 were accepted as significant.

Results:

During the study period 393 patients (50.6% women) with a mean age of 52.47 ± 13.21 years were evaluated. Baseline characteristics are shown in table 1.

Table 1.Baseline characteristicsTotaln=393Female, n (%)199 (50,6)Age, yrs, mean ±SD52,47 (13,21)Source of referral, n (%) Dermatology117 (29,8) Rheumatology219 (55,7) Primary Care and Others22 (5,6)Smoker, n (%)97 (25,8)High Blood Pressure (HBP), n (%)106 (27,7)Diabetes, n (%)48 (12,5)Hypercholesterolemia, n (%)98 (25,8)Hyperuricemia, n (%)32 (8,6)HLA-B27 positive, n (%)68 (21,6)BMI, Kg/m2, mean ±SD28,15 (5,87)Biological treatment, n (%)166 (43,2)

The mean BMI was 28.15 ± 5.87 kg/m2. 112 patients (32%) were overweight with a mean BMI of 27.46 ± 1.55 kg/m2and 118 patients (34%) were obese with a mean BMI of 34.42 ± 5.08 kg/m2. Of the obese patients, 80 (67.8%) had obesity grade 1, 28 (23.7%) grade 2 and 10 (8.5%) grade 3.

Characteristics of the patients according to BMI categories are shown in Table 2.

Table 2.Characteristics according to BMINormal weightn= 118Overweightn= 112Obesityn=118P valueFemale, n (%)66 (55,9)52 (46,4)62 (52,5)nsAge, yrs, mean ±SD47,92 (14,08)54,71 (11,75)54,48 (11,54)<0,001Source of referral, n (%)Ns Dermatology35 (33,7)37 (35,2)34 (30,9) Rheumatology63 (60,6)61 (58,1)70 (63,6) Primary Care and Others6 (5,8)7 (6,7)6 (5,5)Smoker, n (%)37 (33)23 (21,1)31 (26,7)nsHigh Blood Pressure (HBP), n (%)12 (10,5)37 (34,3)41 (35)<0,001Diabetes, n (%)7 (6)9 (8,3)30 (25,6)<0,001Hypercholesterolemia, n (%)19 (17)24 (22,2)45 (38,5)0,001Hyperuricemia, n (%)5 (4,4)7 (6,8)19 (16,7)0,004HLA-B27, n (%)27 (28,7)17 (17,9)13 (12,6)0,016BMI, Kg/m2, media ±DE22,58 (1,78)27,46 (1,55)34,42 (5,08)-Biological treatment, n (%)47 (41,2)45 (40,9)66 (55,9)0,032

We observed that mean age was significantly higher in obese patients (p <0.001), as well as the prevalence of cardiovascular risk factors such as HBP (p <0.001), Diabetes (p <0.001), dyslipidemia (p = 0.001) and hyperuricemia (p = 0.004). Obese patients also received more biological therapy (p=0.032). A higher prevalence of HLA-B27 was observed in patients with normal weight (p=0.016). No differences were found according to BMI regarding gender and source of referral.

Conclusion:

- Almost 70% of patients with PsA visited in the PAIDER clinic of our center have a BMI above normal and more than a third of them are obese, mostly grade 1.

- In our joint clinic there are no differences in BMI regarding the source of referral of the patients.

- Patients with obesity are older, have more cardiovascular comorbidities and receive more biological treatment significantly, which increases the complexity of their management and worsens the prognosis.

Disclosure of Interests:

Andrea García-Guillén: None declared, Ana Laiz: None declared, Anna Lopez-Ferrer: None declared, HyeSang Park: None declared, Patricia Moya: None declared, Berta Magallares: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Ana Milena Millán Arciniegas: None declared, Cesar Díaz-Torné: None declared, Sicylle Jeria: None declared, Hector Corominas: None declared

AB0489 BETA 2 MICROGLOBULIN AS A PROGNOSTIC FACTOR IN CRYOGLOBULINEMIA NON ASSOCIATED WITH HEPATOTROPIC VIRUSES

Background:

Cryoglobulinemia (CG) is a rare phenomenon related to haematological disorders, infections and autoimmune diseases. Age and renal involvement are known prognostic markers.

Objectives:

To describe the differential clinical features and the prognostic factors in a cohort of patients diagnosed with CG non-associated with hepatotropic viruses.

Methods:

A descriptive, retrospective study of a cohort comprised of 252 cryoglobulin positive samples, obtained from the immunology laboratory database of a tertiary hospital attending 450,000 people over 1 year. 186 patients with CG positive samples were included, 87 of which were not associated with neither hepatitis B nor C virus. Demographic, clinical, serological and pathological data were collected. Nonparametric variables were compared using a Wilcoxon test.

Results:

Out of 186 reviewed patients, 87 (46.7%) are included in this study. The mean age at CG diagnosis was 60 (± 16) years. Mixed CG was the predominant subtype, detected in 66 (75.9%) patients, 10 of which (11.5%) were associated with glomerulonephritis (GN) with compatible biopsy, 17 (19.5%) with peripheral neuropathy (PN), 29 (33.3%) with non-erosive arthritis and 10 (11.5%) with leukocytoclastic vasculitis confirmed by skin biopsy. The clinical, epidemiological and serological characteristics of the sample are summarized in Table 1.

Figure 1.

Ing et al’s Nomogram of parsimonious model.

Table 1.

Clinical, epidemiological and serical characteristics of patients with CG

Sex, female / male, n (%)65/22 (74.7/25.3)Age at diagnosis, years ± SD60 ± 16CG subtype, n (%)- Type 1, n (%)27 (30)- Mixed, n (%)61 (70)ASSOCIATED DISEASES- pSS, n (%)37 (42,5)- LES, n (%)9 (10,3)- SSc, n (%)7 (8,05)CLINICAL CHARACTERISTICS- Skin, n (%)30 (34,5)- Purpura, n (%)14(16)- Ulcers, n (%)5 (5,7)- Acral ischemia, n (%)2 (2,3)- Acrocyanosis by cold, n (%)7 (8)- Raynaud, n (%)19 (21,8)- Peripheric Neuropathy, n (%)17 (19,5)- Non-erosive arthritis, n (%)29 (33,3)- Glomerulonephritis, n (%)10 (11,5)LABORATORY- β2M +(>1.8 mg/L) mean3.9- RCP (mg/L) p503.7- ESR (mm/hour) p5028- RF + (>20 UI/mL) p50124- Anti Ro52 + /Anti Ro60 + n, (%)42 (48.3)- Low C3 n, (%)48 (55.1)- Low C4 n, (%)36 (41.4)

In the comparative analysis of patients with CG and Beta 2 microglobulin (β2M), CG and rheumatoid factor (RF), those with high β2M (>1.8 mg / L) presented significantly more GN (p0.016) and PN (p0.013). However, the association of RF with either GN (p0.948) or PN (p0.645) was not significant. Also, high β2M was significantly related to complement consumption of C4 (p: 0.015) but not of C3 (p: 0.063). In the 30 (34.5%) patients with skin manifestations, high β2M showed no statistically significant association. The main systemic autoimmune diseases associated were primary Sjögren’s Syndrome (pSS) 37 (42.5%), Systemic Lupus Erythematosus (SLE) 9 (10.3%) and Systemic Sclerosis (SSc) 7 (8.05%).

Conclusion:

A direct association between presence of elevated levels of β2M and the existence of progression to glomerulonephritis and peripheral neuropathy is found in our cohort. No correlation is found between the presence of CG and other serological markers of autoimmunity except low C4. CG with elevated β2M does not associate with greater skin involvement or arthritis.

References:

[1]A.C. Desbois et al. Cryoglobulinemia: An update in 2019. Joint Bone Spine (2019)

[2]Cacoub P, Cryoglobulinemia Vasculitis, The American Journal of Medicine (2015)

Disclosure of Interests:

None declared

SAT0217 PERFORMANCE OF ACR/EULAR 2019, SLICC 2012 AND ACR 1997 CLASSIFICATION CRITERIA IN A COHORT OF SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITH LONGSTANDING DISEASE

Background:

Systemic lupus erythematosus (SLE) is an autoimmune disease with variable clinical features and a complex physiopathology. In 2019, EULAR and ACR have jointly developed new classification criteria with both high sensitivity and specificity. These criteria have the particularity of including the presence of ANA as an obligatory entry criterion and the existence of clinical and immunological domains with weighted scores.

Objectives:

To evaluate the performance and characteristics of the ACR/EULAR 2019, SLICC 2012 and ACR 1997 classification criteria in a cohort of SLE patients with longstanding disease.

Methods:

Descriptive observational study that enrolled a cohort of SLE patients with longstanding disease followed in a tertiary level hospital. Demographic and clinical data were gathered along with the fulfillment of classification criteria. The sensitivity of each classification criteria and the statistically significant associations between criteria fulfillment and clinical and immunological data were calculated. Statistical analyses were performed using the Chi2, T-student and ANOVA tests. Statistical significance was assumed in p values <0.05.

Results:

A total of 79 patients (88.6% women) with a mean age of 51.8±14 years, disease duration of 15.2±11.5 years and SLEDAI of 2.65±2.1 were included. The sensitivity of the different classification criteria was 51.9% for ACR 1997, 87.3% for SLICC 2012 and 86.1% for ACR/EULAR 2019 (Table 1).

Table 1.

Sensitivity and average scores.

ACR/EULAR 2019SLICC 2012ACR 1997Sensitivity (%)86.187.351.9Average score of patients classified as SLE(±SD)18.6±5.85.3±1.45±0.9Average score of patients NOT classified as SLE(±SD)6.1±2.52.8±0.42.8±0.8

51.9% of patients met all three classification criteria, 29.1% met SLICC 2012 and ACR/EULAR 2019, 5% only met SLICC 2012 and 3.7% exclusively met ACR/EULAR 2019. 11.4% of patients did not meet any classification criteria and were characterized by having a low SLEDAI (0.6±0.9) and fulfilling only skin domains (alopecia or oral ulcers), antiphospholipid antibodies or hypocomplementemia.

Statistically significant associations were found between meeting ACR/EULAR 2019 classification criteria and the presence of low C3 and C4 (p<0.04), DNA (p<0.001), lupus nephritis III-IV (p<0.05) and arthritis (p<0.001), highlighting that all patients with arthritis met these criteria.

In the SLICC 2012 evaluation, significant associations were found between meeting these criteria and the presence of arthritis (p<0.01), renal involvement (p<0.04), leukopenia/lymphopenia (p=0.05), DNA (p<0.03) and hypocomplementemia (p=0.02).

Fullfilment of ACR 1997 was associated to the presence of malar rash (p<0.001), discoid lupus (p<0.05), photosensitivity (p<0.001) and oral ulcers (p<0.04), as well as arthritis (p<0.001), serositis (p=0.02), renal (p<0.05) and hematologic (p=0.05) involvement.

The Kappa concordance coefficient among classification criteria is detailed in Table 2.

Table 2.

Kappa concordance coefficient.

ACR/EULAR 2019 - SLICC 2012ACR/EULAR 2019 - ACR 1997SLICC 2012 - ACR 1997Kappa concordance coefficient0.610.270.30

Conclusion:

The ACR/EULAR 2019 classification criteria maintain a high sensitivity similar to the SLICC 2012 in SLE patients with longstanding disease, both of which are much higher than ACR 1997. Patients with serological, articular or renal involvement are more likely to meet SLICC 2012 or ACR/EULAR 2019 criteria. It is noteworthy the relevance of dermatological manifestations in ACR1997 classification criteria against the increased weight that a better understanding of SLE physiopathology has provided to analytic and immunological criteria in the subsequent classification criteria.

Disclosure of Interests:

David Lobo Prat: None declared, Berta Magallares: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, HyeSang Park: None declared, Patricia Moya: None declared, Ignasi Gich: None declared, Ana Laiz: None declared, Cesar Díaz-Torné: None declared, Ana Milena Millán Arciniegas: None declared, Susana P. Fernandez-Sanchez: None declared, Hector Corominas: None declared

FRI0442 APPROPRIATE USE OF SEROLOGY TESTS FOR THE DIAGNOSIS OF LYME DISEASE. EXPERIENCE IN AN URBAN AREA

Background:

Lyme disease (LD) is a multisystemic animal-borne disease caused by spirochetes of theBorrelia burgdorferi s.lcomplex and transmitted by ticks of the speciesIxodes ricinus. In Spain, most cases occur in rural areas of the north-east region with a peak of maximum incidence between spring and early autumn. The diagnosis is based on a history of potential exposure to ticks, the recognition of characteristic clinical manifestations and serological testing.

Objectives:

To assess the suitability of serological study for the diagnosis of LD in an urban area.

Methods:

Retrospective observational study that included all LD serology tests made between April 2017 and September 2019 at a tertiary hospital in Barcelona covering a population of 450,000 people. Demographic data and the medical department that requested the serology test were collected along with serology test results. The medical records of patients with positive serology were consulted to identify which patients were finally diagnosed with LD along with their clinical manifestations, treatment and outcome.

Results:

A total of 574 serological tests were included and 78 (13.59%) of them were positive. Only 1.04% (6) of all serological tests belonged to patients finally diagnosed with LD. The department that made most requests was Neurology (37.3%) followed by Infectious Diseases (21%), Internal Medicine (14.5%), Emergency Medicine (4.7%), Dermatology (4.5%), Critical Care Medicine (2.3%) and Rheumatology (2.1%). 50% of the diagnosed patients were women with a mean age of 57.7±7.7DE years. In 50% of diagnosed cases, patients remembered a tick bite during activities in the mountain or rural areas. The most common clinical manifestations were erythema migrans (67%), non-inflammatory arthralgias (50%), fatigue and malaise (67%), together with one case of meningoencephalitis and one of knee monoarthritis. All diagnosed patients received antibiotic treatment with ceftriaxone (33%) or doxycycline (66%). Only one patient presented post-Lyme syndrome.

The serological test for LD in our center had a total individual cost of 15.75 eur, so the cost of the 574 requests was 9,040.5 eur. 7,812 eur corresponded to negative results and 1,134 eur to false positive results.

Conclusion:

Our study indicates the overuse of diagnostic testing for LD with implications for patient care and cost-effective health management. In the absence of a history of potential exposure to infected vector ticks or characteristic clinical manifestations, unnecessary microbiological tests should not be performed.

Disclosure of Interests:

David Lobo Prat: None declared, Luís Sainz Comas: None declared, Virginia Pomar: None declared, Ana Milena Millán Arciniegas: None declared, HyeSang Park: None declared, Andrea García-Guillén: None declared, Sicylle Jeria: None declared, Ana Laiz: None declared, Berta Magallares: None declared, Ivan Castellví Consultant of: Boehringer Ingelheim, Actelion, Kern Pharma, Speakers bureau: Boehringer Ingelheim, Actelion, Bristol-Myers Squibb, Roche, Patricia Moya: None declared, Cesar Díaz-Torné: None declared, Susana P. Fernandez-Sanchez: None declared, Hector Corominas: None declared

The safety of ustekinumab for the treatment of psoriatic arthritis

INTRODUCTION

The cytokines interleukin (IL)-12 and IL-23 have been involved in the pathogenesis of psoriasis and psoriatic arthritis. Ustekinumab is a fully human monoclonal antibody targeting the p40 subunit shared by IL-12 and IL-23. Ustekinumab prevents the interaction of IL-12 and IL-23 binding to their receptors, blocking the T1 and T17 inflammatory pathways. Ustekinumab has been evaluated for the treatment of various chronic immune mediated diseases including psoriasis and psoriatic arthritis (PsA). Most of the data regarding the safety of ustekinumab come from the experience treating patients with psoriasis, but clinical trials have demonstrated its efficacy and safety in the treatment of both diseases. The most common adverse events observed during the clinical trials are mild in intensity, and include respiratory tract infections, nasopharyngitis, headache and injection site reactions. Throughout long-term ustekinumab treatment, serious infections or major cardiovascular adverse events occurred rarely. Areas covered: In this review we report the safety data that come from phase II and phase III clinical trials that assay the efficacy and safety of ustekinumab in PsA, including recently published data corresponding to long-term studies. Relevant references were obtained through a literature search in MEDLINE/Pubmed (search strategy: ustekinumab AND psoriatic arthritis) for articles published until November 2016, complemented by a manual search. Expert opinion: In clinical practice, ustekinumab is generally a well-tolerated treatment, and the safety profile in psoriatic arthritis is similar to that reported in plaque psoriasis.

Impact of 3-Monthly Vitamin D Supplementation Plus Exercise on Survival after Surgery for Osteoporotic Hip Fracture in Adult Patients over 50 Years: A Pragmatic Randomized, Partially Blinded, Controlled Trial

OBJECTIVE

To determine whether 3-monthly supplementation of an oral vitamin D widely used in Spain (calcifediol) plus daily exercise could influence survival at one and four years after surgery for osteoporotic hip fracture.

DESIGN

A pragmatic, randomized, partially single-blind placebo-controlled study.

SETTING

Patients admitted to a tertiary university hospital for acute hip fracture.

PARTICIPANTS

675 healthy adult patients undergoing surgery for osteoporotic hip fracture were recruited from January 2004 to December 2007.

INTERVENTION

Patients were randomized to receive either 3-monthly oral doses of 3 mg calcifediol (Hidroferol Choque®) or placebo in the 12 months postsurgery. Patients who received calcifediol were also given an exercise programme. The placebo group received standard health recommendations only.

MEASUREMENTS

The primary endpoint was survival at 1 year and at 4 year follow-up. We also recorded new fractures, medical complications and anti-osteoporotic treatment compliance.

RESULTS

We included a total of 88 patients, aged 62 to 99 years. Mean age was 82 years and 88.6% were women. At 12 months, 10 (11.3%) patients had died, 9 of them, from the non-intervention group. At 4 years after surgery, 20 (22.7%) had died, 3 (3.4%) from the intervention group and 17 (19.3%) from the non-intervention group. At this time, survival curve analysis showed 93% survival in the intervention group and 62% in the non-intervention group (p=0.001). At 12-month follow up, there were 18 new fractures, 9 in each group. The non-intervention group had more medical complications, with significant differences at visit 2 (p = 0.04) and 3 (p = 0.02) but not at visit 4 (p = 0.18). No significant differences between groups were found regarding treatment compliance.

CONCLUSION

3-monthly, oral supplements of 3 mg calcifediol plus daily exercise improved survival at one-year and four-year follow up after surgery for an osteoporotic hip fracture.