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Stazi M, Megighian A, D'Este G, Negro S, Ivanušec A, Lonati D, Pirazzini M, Križaj I, Montecucco C. An agonist of CXCR4 induces a rapid recovery from the neurotoxic effects of Vipera ammodytes and Vipera aspis venoms. J Neurochem 2024; 168:428-440. [PMID: 36912731 DOI: 10.1111/jnc.15803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 03/14/2023]
Abstract
People bitten by Alpine vipers are usually treated with antivenom antisera to prevent the noxious consequences caused by the injected venom. However, this treatment suffers from a number of drawbacks and additional therapies are necessary. The venoms of Vipera ammodytes and of Vipera aspis are neurotoxic and cause muscle paralysis by inducing neurodegeneration of motor axon terminals because they contain a presynaptic acting sPLA2 neurotoxin. We have recently found that any type of damage to motor axons is followed by the expression and activation of the intercellular signaling axis consisting of the CXCR4 receptor present on the membrane of the axon stump and of its ligand, the chemokine CXCL12 released by activated terminal Schwann cells. We show here that also V. ammodytes and V. aspis venoms cause the expression of the CXCL12-CXCR4 axis. We also show that a small molecule agonist of CXCR4, dubbed NUCC-390, induces a rapid regeneration of the motor axon terminal with functional recovery of the neuromuscular junction. These findings qualify NUCC-390 as a promising novel therapeutics capable of improving the recovery from the paralysis caused by the snakebite of the two neurotoxic Alpine vipers.
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Affiliation(s)
- M Stazi
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - A Megighian
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - G D'Este
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - S Negro
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - A Ivanušec
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
- Doctoral School, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - D Lonati
- Pavia Poison Control Centre - National Toxicology Information Centre - Clinical and Experimental Lab, Toxicology Unit, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - M Pirazzini
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - I Križaj
- Department of Molecular and Biomedical Sciences, Jožef Stefan Institute, Ljubljana, Slovenia
| | - C Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- National Research Council, Institute of Neuroscience, Padova, Italy
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Codullo V, Monti S, Perotti C, Milanesi A, Rossi S, Gallotti A, Cobianchi L, Montecucco C, Delvino P. Severe immunoglobulin A vasculitis with refractory gastrointestinal involvement in an adult patient successfully treated with plasma exchange. Scand J Rheumatol 2024:1-2. [PMID: 38445492 DOI: 10.1080/03009742.2024.2318947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Affiliation(s)
- V Codullo
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Monti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Perotti
- Immunohematology and Transfusion Medicine Service, IRCCS Fondazione Policlinico San Matteo di Pavia, Pavia, Italy
| | - A Milanesi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Experimental Medicine, University of Pavia, Pavia, Italy
| | - S Rossi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Gallotti
- Radiology Department, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - L Cobianchi
- General Surgery 1, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - C Montecucco
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - P Delvino
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Experimental Medicine, University of Pavia, Pavia, Italy
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De Stefano L, Guerini M, Pelizza J, Ferracane G, Piccin V, Montecucco C, Bugatti S. A case of a rheumatoid nodule on the aortic valve in a patient with rheumatoid arthritis in sustained remission with anti-TNFα. Scand J Rheumatol 2023; 52:577-579. [PMID: 37139805 DOI: 10.1080/03009742.2023.2201065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023]
Affiliation(s)
- L De Stefano
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Guerini
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - J Pelizza
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Ferracane
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Piccin
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Montecucco
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Bugatti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bozzalla Cassione E, Grignaschi S, Xoxi B, Greco MI, Luvaro T, Mazzucchelli I, Bugatti S, Montecucco C, Manzo A. AB0185 PHENOTYPES OF DRUG-FREE RHEUMATOID ARTHRITIS FLARE AND IMPACT OF RESIDUAL SUBCLINICAL ECOGRAPHIC JOINT INJURY IN ACPA POSITIVE AND ACPA NEGATIVE DISEASE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe mechanisms of flare across the pathogenic spectrum of RA remain unclear. To what extent RA flare reproduces the dynamics of disease onset or is primarily driven by new dynamics is not known. Furthermore, the hypothesis of a role for circulating auto-antibodies in determining different mechanism behind flare has never been challenged.ObjectivesTo evaluate whether RA flare after remission achievement reproduces the phenotype of onset or it is characterized by a different phenotype primarily driven by the pattern of residual joint injury after treatment, in ACPA positive and negative patients.Methods53 RA patients, in stable drug-free remission (DFR) after early csDMARDS introduction and displaying clinical flare across 60 months of follow-up were analysed for clinical, laboratory and ultrasound (US) characteristics at diagnosis, treatment discontinuation, and flare (DAS28- and/or physician-based flare). We compared the synovitis clinical phenotype (ACR 1987 criteria defined districts), PROs and the inflammatory status at disease flare versus onset. We then measured the impact of residual subclinical US joint injury (absence of objective synovitis and GS>1 and/or PD>0) at the time of drug discontinuation, on the synovitis clinical phenotype of flare. Finally, we explored differences in the outcomes in ACPA positive and negative RA.ResultsCohort characteristics are shown in Table 1. As inferred by paired analyses, no significant differences were observed between onset and flare concerning composite indices of disease activity, and subjective/semi-objective domains. However, flare appeared to be significantly less inflammatory in terms of CRP, ESR, SJC, morning stiffness and HAQ (p<0.05). These differences remained after adjustment for diagnostic delay including only very early RA patients (<3 months from symptoms’ onset). The evaluation of the frequency of articular districts’ involvement revealed no difference between onset and flare both for SJC and TJC (Figure 1). However, the percentage of SJs at flare being present at onset showed a high variability among patients. Stratification for ACPA status demonstrated a significantly higher recurrence of synovitis in joints involved at onset in ACPA negative vs ACPA positive patients (p<0.05). The percentage of SJs at flare presenting residual subclincal US injury at the time of drug discontinuation was significantly higher in ACPA negative vs ACPA positive patients (p<0.05) and negatively correlates with the ACPA titer (R 0.354, p>0.05).Table 1.Comparison between Onset and FlareOnset,median (IQR)Flare,median (IQR)Sex, female (%)34 (64)\Age at Symptoms onset (yrs)57 (43-65)\Diagnostic delay(months)3 (2-7)1.5 (1-2) *ESR (mm/h)20.0 (12.0-38.5)17 (9.00-27.0)§CRP (mg/dL)0.640 (0.307-2.11)0.370 (0.220-1.05) *§HAQ0.625 (0.375-1.13)0.438 (0.125-0.875)GH40.0 (26.5-50.0)40 (30.0-50.0)PGA50.0 (27.0-66.5)49 (20.0-70.0)EGA38.0 (27.0-60.0)40 (30.0-60.0)SJC/667 (4.00-10.0)4 (3.00-6.00) *§TJC/685 (2.00-10.0)5 (2.00-11.0)DAS28-ESR4.55 (3.29-5.36)3.98 (3.56-4.61)DAS28-CRP3.98 (3.08-4.88)3.83 (3.00-4.27)Morning Stiffness (minutes)60.0 (11.3-90.0)10 (1.00-30.0) *§Index: *significant compared to onset, § significant compared to onset considering only VERAConclusionRA flare in patients achieving DFR seems to be less severe in terms of inflammatory markers and synovitis recurrence, despite a similar degree of joint tenderness and patients’ perception compared to disease onset. The arthritis phenotype undergoes detectable changes more in ACPA positive than negative patients. The residual subclinical US joint damage seems to drive the localization of synovitis recurrence in ACPA negative more than positive patients, supporting the existence of pathologic differences in the process of disease reactivation in the two groups.Disclosure of InterestsNone declared
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Di Cianni F, Cardelli C, Italiano N, Laurino E, Moretti M, Depascale R, Gamba A, Iaccarino L, Doria A, Sousa Bandeira MJ, Dinis SP, C Romão V, Alessandri E, Gotelli E, Paolino S, DI Giosaffatte N, Grammatico P, Ferraris A, Cavagna L, Montecucco C, Longo V, Beretta L, Cavazzana I, Fredi M, Tincani A, D’urzo R, Bombardieri S, Burmester GR, Cutolo M, Fonseca JE, Frank CH, Galetti I, Hachulla E, Houssiau F, Marinello D, Müller-Ladner U, Schneider M, Smith V, Talarico R, Van Laar JM, Vieira A, Tani C, Mosca M. POS1232 LONG-TERM OUTCOMES OF COVID-19 VACCINATION IN PATIENTS WITH RARE AND COMPLEX CONNECTIVE TISSUE DISEASES: AN AD-INTERIM ANALYSIS OF ERN-ReCONNET VACCINATE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSince the COVID-19 vaccination campaign was launched all over Europe, there has been general agreement on how benefits of SARS-CoV2 vaccines outweigh the risks in patients with rare connective tissue diseases (rCTDs). Yet, there is still limited evidence regarding safety and efficacy of such vaccines in these patients, especially in the long-term. For this reason, in the framework of ERN-ReCONNET, an observational long-term study (VACCINATE) was designed in order to explore the long-term outcome of COVID-19 vaccination in rCTDs patients. The consent form was developed thanks to the involvement of the ERN ReCONNET ePAG Advocates (European Patients Advocacy Group).ObjectivesTo evaluate the safety profile of COVID-19 vaccination in rCTDs patients and the potential impact on disease activity. Primary endpoints were the prevalence of adverse events (AEs) and of disease exacerbations post-vaccination. Secondary endpoints were the proportion of serious adverse events (SAEs) and adverse events of special interest for COVID-19 (adapted from https://brightoncollaboration.us/wp-content/uploads/2021/01/SO2_D2.1.2_V1.2_COVID-19_AESI-update-23Dec2020-review_final.pdf)MethodsThe first ad-interim analysis of the VACCINATE study involved 9 ERN-ReCONNET Network centres. Patients over 18 years of age with a known rCTD and who received vaccine against COVID-19 were eligible for recruitment. Demographic data and diagnoses were collected at the time of enrolment, while the appearance of AEs and potential disease exacerbations were monitored after one week from each vaccination dose, and then after 4, 12 and 24 weeks from the second dose. A disease exacerbation was defined as at least one of the following: new manifestations attributable to disease activity, hospitalization, increase in PGA from previous evaluation, addition of corticosteroids or immunosuppressants.ResultsA cohort of 300 patients (261 females, mean age 52, range 18-85) was recruited. Systemic lupus erythematosus (44%) and systemic sclerosis (16%) were the most frequent diagnoses, followed by Sjogren’s syndrome (SS,12%), idiopathic inflammatory myositis (IMM,10%), undifferentiated connective tissue disease (UCTD,8%), mixed connective tissue disease (MCTD,4%), Ehlers-Danlos’s syndrome (EDS,4%), antiphospholipid syndrome (APS,2%). AEs appearing 7 days after the first and second doses were reported in 93 (31%) and 96 (32%) patients respectively, mainly represented by fatigue, injection site reaction, headache, fever and myalgia. Otitis, urticaria, Herpes Simplex-related rash, stomatitis, migraine with aura, vertigo, tinnitus and sleepiness were reported with very low frequency. Less than 2% of patients experienced AEs within 24 weeks from the second dose. No SAEs or AEs of special interest were observed in the study period. There were 25 disease exacerbations (8%), 7 of which severe. The highest number of exacerbations was observed after 4 weeks from the second dose (12 within week 4, 6 within week 12 and 7 within week 24). Disease exacerbation was most frequent in patients with EDS (33%) and MCTD (25%).ConclusionThis preliminary analysis shows that COVID-19 vaccination is safe in rCTDs patients. AEs appear most often early after vaccination and are usually mild. Disease exacerbations are not frequent, but can be potentially severe and tend to occur most frequently within the first month after vaccination. Exacerbations can also occur 3-6 months after vaccination, although a causal relationship with the vaccination remains to be established. Our present data underline the importance of long-term observational studies.Table 1.AEs and disease exacerbations per diseaseDiagnosisPatients enrolled (%) (n=300)EAs after 1st and 2nd dose (%)Exacerbations (%)APS25714EDS45033IIM10527MCTD44225SS12598SLE44698SSC16492UCTD850-AcknowledgementsVACCINATE is a study promoted by the European Reference Network on rare and complex connective tissue diseases, ERN ReCONNET. This publication was funded by the European Union’s Health Programme (2014-2020)Disclosure of InterestsNone declared
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Monti S, Bozzalla Cassione E, Biggioggero M, Crepaldi G, Bazzani C, Lomater C, Gorla R, Favalli E, Balduzzi S, Caporali R, Montecucco C. AB0224 JAK-INHIBITORS ATTAIN A RAPID AND PERSISTENT EFFECTIVENESS ON SEVERAL PATIENT-REPORTED OUTCOMES IN LONG-STANDING RHEUMATOID ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundJanus kinase inhibitors (JAKi) are efficacious drugs for the control of disease activity in rheumatoid arthritis (RA). The effect on patient-reported outcomes (PROs) has been shown in randomized clinical trials, but is still largely unknown in real-life scenarios.ObjectivesTo assess the time to onset and magnitude of improvement across a number of different PROs in patients with RA treated with JAKi.MethodsPatients were selected from centres involved in the LORHEN Registry. Patients with a diagnosis of RA initiating a JAKi (Baricitinib or Tofacitinib) between May 2019 and February 2020 were clinically assessed at baseline, 8 weeks and 16 weeks with DAS28 and SDAI. PROs were collected at baseline, 2 weeks, 4 weeks, 8 weeks and 16 weeks from JAKi initiation. The PROs assessed at each timepoint were: Patient Global Assessment (PGA), General Health (GH), 0-100 mm visual analogue scale (VAS)-pain, VAS-fatigue, Health Assessment Questionnaire (HAQ), The Clinical Arthritis Activity (PRO-CLARA) questionnaire.ResultsThirty-eight patients (female 76%, mean age 57±15) were enrolled for a total of 152 visits for PROs assessments. Patients had received a median of 2 (IQR 1;3) previous conventional synthetic DMARDs (csDMARD) and a median of 2 (0;3) biological DMARDs. Mean disease duration at time of JAKi initiation was 10±9.5 years. JAKi was prescribed as combination therapy with a csDMARD in 20 (53%), concomitant glucocorticoids (GC) in 28 (73%) patients, at a mean dose of 6±2 mg/day. Twenty-one (55) patients were on regular analgesics. DAS28-ESR reduced from 4.5±0.9 at baseline to 2.6±0.9 at 8 weeks (p<0.001). DAS28-ESR remained stable between 8 and 16 weeks (mean values 2.3±0.1; p=0.17). Similarly, DAS28-CRP reduced from 4.1±0.8 to 2.1±0.6 at 8 weeks (p<0.0001). Between 8 and 16 weeks there was a further significant reduction of DAS28-CRP under the effect of JAKi treatment to a mean value of 1.4±0.5 (p<0.0001). SDAI reduced over the period of observation from 19±8 to 6±5 at 8 weeks (p<0.0001), and to 4±3 at 16 weeks (0.03). By week 8 the intake of concomitant GC reduced to 28% of patients (p=0.0001), and of analgesics to 2% of patients (p<0.0001).By two weeks, all PROs had a significant reduction compared to baseline (Figure 1). For PGA, VAS-pain, VAS-fatigue a further significant reduction was observed by week 4 to then stabilize between week 8 and 16. GH and HAQ had a significant reduction by week 2 and remained stable thereafter. All PROs were significantly lower during all time-points compared to baseline. The PRO-CLARA Road score to assess physical function significantly improved starting from week 2 from a score of 4±2 to 2±2 at the end of follow-up. The PRO-CLARA self-administered tender joint count was stable at week 2 (mean score 4±2) but recorded an improvement from week 4 onwards (p<0.03).Figure 1.Improvement of patient-reported outcomes over the period of observationConclusionTreatment with JAKi ensures a very rapid and persistent improvement of several PROs, including pain, fatigue and physical function, as early as 2 weeks treatment even in patients with long-standing RA treated with several lines of previous DMARDs.Disclosure of InterestsNone declared
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Delvino P, Monti S, Grieco GP, Bozzalla Cassione E, Franchi G, Bogliolo L, Montecucco C. AB0617 High prevalence of osteoporosis and fragility fractures in patients with ANCA-associated vasculitis: a cross-sectional study. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe advent of effective immunosuppressive treatments significantly improved the prognosis of ANCA-associated vasculitides (AAV), which have become chronic relapsing diseases. Patients with inflammatory rheumatic disorders are particularly prone to reduced bone mineral density (BMD) and fragility fractures (FF), due to chronic glucocorticoid therapy, immunosuppressant-induced hypogonadism, systemic inflammation, functional disability and comorbidities. At present, there is paucity of data concerning the risk of osteoporosis and FF in AAV.ObjectivesTo describe the occurrence of osteoporosis and major FF in a cross-sectional cohort of patients with AAV.MethodsPatients diagnosed with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), according to ACR criteria and/or Chapel Hill definitions and regularly followed-up in our vasculitis center were included. BMD was measured by dual-energy X-ray absorptiometry (DEXA) of the proximal femur and lumbar spine, between March 2016 and September 2021. Osteoporosis was defined by a T-score below –2.5 SD, whereas osteopenia was defined by a T-score between -1 and -2.5 SD, according to the World Health Organization criteria. Vertebral fractures were assessed by X-ray of the dorso-lumbar spine. Data on previous osteoporotic hip fractures were collected.ResultsSixty-two consecutive patients were included (59.7% female, mean age at time of DEXA 61.8±10.5 years, disease duration 97.0±76.1 months). Sixteen (25.8%), 8 (12.9%) and 38 patients (61.3%) were affected by GPA, MPA and EGPA, respectively. BMD findings indicating osteoporosis and osteopenia, at either the lumbar spine and/or the proximal femur, were observed in 15 (24.2%) and 39 patients (62.9%), respectively, whilst only 8 patients (12.9%) had normal BMD values at both sites. Fifteen patients (24.2%) reported 51 major FF (50 vertebral fractures, 1 hip fracture) during follow-up, with multiple major FF being recorded in 10 patients (16.1%). Osteoporosis, at least at one site, was frequent not only in post-menopausal women (19.4%), but also in 6 males (24%), 3 pre-menopausal women (50%) and 3 patients under 50 years of age (37.5%), respectively (Figure 1). Similarly, major FF occurred in 4 males (16.7%), 1 pre-menopausal female (16.7%) and 1 patient under 50 years of age (12.5%), respectively (Figure 1). Patients with osteoporosis presented a lower body mass index (BMI) (23.1±4.1 vs 25.9±4.4, P=0.03) and a higher prevalence of major FF (53.3% vs 14.9%, P=0.003) compared to patients without osteoporosis. Compared to patients without major FF, those affected by major FF were older (68.8±1.8 vs 59.4±9.3 years, P=0.003), had a higher disease duration (146.9±78.8 vs 81.8±68.9 months, P=0.003) and presented with lower proximal femur BMD values (0.657±0.122 vs 0.761±0.127 g/cm2, P=0.007) and proximal femur T-score (-2.0±0.9 vs -1.4±0.8 SD). Notably, 7 out 15 patients with FF (46.7%) did not exhibit BMD findings of osteoporosis. Other variables, including sex, disease subtype, ANCA status, chronic kidney disease or treatment with cyclophosphamide were not related to bone loss or FF.Figure 1.Proportion of patients with osteopenia, osteoporosis and major fragility fractures stratified according to sex, menopausal status and age.ConclusionPatients with AAV are particularly susceptible to BMD loss and fractures, with osteoporosis and major FF being reported in about a quarter of patients. Short-term and long-term monitoring for reduced BMD and FF is warranted in all patients with AAV, including male patients, premenopausal females and those under 50 years of age.Disclosure of InterestsNone declared
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Bixio R, Milanesi A, Viapiana O, Montecucco C, Bugatti S, Rossini M. AB0900 A temporary antirheumatic drugs withdrawal does not cause an excess of disease flares in patients with psoriatic arthritis undergoing Covid-19 mRNA vaccination. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe best way to manage disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatic and musculoskeletal diseases (RMDs) undergoing the Coronavirus disease (Covid)-19 vaccination and the recommendations regarding the use and timing of immunomodulatory therapies around the time of vaccination are still a matter of debate, due to the difficulties in balancing the vaccination efficacy and safety.ObjectivesTo assess the impact of different strategies of antirheumatic treatment management on disease activity around the time of vaccination for Coronavirus disease (Covid)-19 in patients with psoriatic arthritis (PsA).MethodsWe prospectively evaluated patients with PsA in remission or low-disease activity candidate to receive Covid-19 vaccination with mRNA vaccines. Methotrexate (MTX) and leflunomide were withheld 7 days after each dose, whilst biological DMARDs (bDMARDs), were either continued (46.8% of the patients) or withheld (53.2%) from the day of the first dose until 7 days after the second dose. Patients were reassessed after 3 months from enrollment or in case of disease flare.ResultsAfter the second dose of Covid-19 vaccination 7 patients (5.6%) (6 females) had an articular disease flare each (mean involved joints: 1.29), one patient presented a concomitant worsening of psoriasis, and four patients had an isolated worsening of their psoriasis. All patients received additional treatments with oral GC (n=2) or non-steroidal anti-inflammatory drugs (n=5). Two flares lasted more than one week and required a modification of the ongoing bDMARD. Articular flare incidence (6.8% vs 3%, p=0.259), involved joints (1.4 vs 1.5, p=0.846), disease flare severity, and changes in antirheumatic therapies (1 vs 1, p=0.928) did not differ significantly between the two different bDMARD management strategy groups (continued vs temporary withheld). There was no significant difference in disease activity score for psoriatic arthritis (DAPSA) and C-reactive protein (CRP) after vaccination, but patients who flared up had a higher mean basal DAPSA (7.3 vs 4.1, p=0.046). On binomial logistic regression analysis, we did not find any significant association with gender, age, basal CRP, basal DAPSA, active psoriasis, conventional synthetic DMARDs, or bDMARDs and disease flare.ConclusionOur findings suggest that a temporary short halt of bDMARDs could be a viable option in patients with well-controlled PsA undergoing Covid-19 vaccination without increasing the risk of flares, which could be useful to increase T cell response and antibody titres after Covid-19 vaccination.Disclosure of InterestsNone declared
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Treppo E, Isola M, De Martino M, Padoan R, Urban ML, Monti S, Sartorelli S, Giollo A, Argolini LM, Marvisi C, Ferro F, Cassone G, Motta F, Berti A, Conticini E, Manfredi A, Frediani B, Bortolotti R, Selmi C, Baldini C, Emmi G, Caporali R, Rossini M, Dagna L, Montecucco C, Schiavon F, Salvarani C, De Vita S, Quartuccio L. AB0627 Evaluation of internal consistency, feasibility, and reliability of the Italian version of ANCA-associated vasculitis patient-reported outcome (AAV-PRO_ita) questionnaire: preliminary results from a multicenter study on a large cohort of Italian patients. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe ANCA-associated vasculitis patient-reported outcome (AAV-PRO) questionnaire is a 29-item disease-specific PRO measure for AAV[1]. The Italian version of the AAV-PRO questionnaire (AAV-PRO_ita) was translated in collaboration with Oxford and Bristol University (UK) and was preliminarily tested on a single-center Italian cohort[2].ObjectivesThe main objective of this multicentric study was to assess the internal consistency, feasibility, and reliability of the AAV-PRO_ita in a large cohort of Italian AAV patients. The secondary objective was to investigate the clinical characteristics of AAV patients associated with AAV-PRO_ita domains.MethodsThe AAV-PRO_ita is describes the following disease domains: (1) organ-specific and systemic symptoms and signs (SSS); (2) physical function (PF); (3) social and emotional impact (SEI). In this study, Italian-speaking AAV patients were recruited from Italian Centres (N=13) with a large experience in the diagnosis and treatment of systemic vasculitis, belonging to the Vasculitis Study Group of the Italian Society of Rheumatology. Inclusion criteria were: a confirmed diagnosis of GPA, MPA, or EGPA; ANCA positivity in at least once occasion or biopsy-proven AAV; and age ≥18 years old. Participants completed the AAV-PRO_ita at three different time-points: baseline, after 5-7 days, and at month 3.Results229 AAV-patients (56.3% women) with a median age of 61 (IQR 51-72) were recruited and completed the questionnaires. The subtype of AAV was mainly GPA (131, 57.2%), followed by EGPA (58, 25.3%), and MPA (40, 17.5%). Median BVASv3 at baseline was 0 (IQR 0-3), whereas the median BVASv3 at the onset of disease was 14 (IQR 9-20). Participants had a median duration of disease of 67 (IQR 24-126) months. Patients who experienced at least one relapse, one hospitalization, and one severe infection were 40.2%, 53.3%, and 24%, respectively. 83% of the patients were on immunosuppressant therapy and 71.6% were still receiving glucocorticoids (GC).AAV-PRO_ita questionnaire had good internal consistency (Cronbach’s Alpha range 0.81-0.93) and good test-retest reliability (ICCs range 0.93-0.96). Item response rates were high overall (maximum 0.87% missing data), supporting the feasibility of the questionnaire.Concerning the domains of the questionnaire, female AAV patients scored higher (i.e. worse) in all three domains, especially in the SEI domain (p-value<0.001). Older participants (≥65 years) scored higher in the PF domain (p-value<0.05) in all three times of self-completions of the questionnaire. The ongoing treatment also influenced the results. In fact, patients on GC showed higher scores in the PF domain (p-value=0.003) and SEI domain (p-value=0.021). The VDI value seemed to be related to AAV-PRO_ita scores more than disease duration or disease activity, especially in the SSS domain (ρ>0.3, p-value<0.001). Conversely, subtype of AAV did not influence the item scores.ConclusionThe AAV-PRO_ita questionnaire is a new 29-item, disease-specific PRO measure for use in AAV in the Italian language. It is a self-administered Italian questionnaire with good internal consistency, feasibility, and reliability. AAV-PRO_ita proved to be a useful tool to explore the AAV patient’s perception of quality of life, and it could become an important way of measuring the unmet needs of AAV patients.References[1]Robson, J.C. et al. Validation of the ANCA-Associated Vasculitis Patient-Reported Outcomes (AAV-PRO) Questionnaire. Ann. Rheum. Dis.2018, 77, 1157–1164, doi:10.1136/annrheumdis-2017-212713.[2]Treppo, E.; Palese, A.; Vita, S.D.; Quartuccio, L. AB0392 PRELIMINARY VALIDATION OF THE ITALIAN VERSION OF ANCA-ASSOCIATED VASCULITIS PATIENT-REPORTED OUTCOME (AAV-PRO_ita) QUESTIONNAIRE: FATIGUE AND CHRONIC PAIN AS UNMET NEEDS BY CURRENT TREATMENTS. Ann. Rheum. Dis.2021, 80, 1224–1224, doi:10.1136/annrheumdis-2021-eular.2123.AcknowledgementsWe thank the Italian Study Group on Systemic Vasculitis.Disclosure of InterestsNone declared
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Fornaro M, Franceschini F, Gremese E, Cauli A, Sebastiani M, Montecucco C, Conti F, Rossini M, Foti R, Cantatore FP, Fusaro E, Lomater C, Frediani B, Govoni M, Atzeni F, Ramonda R, D’angelo S, Ferraccioli G, Lapadula G, Caporali R, Iannone F. POS0634 SAFETY PROFILE OF b/tsDMARD IN RHEUMATOID ARTHRITIS PATIENTS WITH IMPAIRED GLOMERULAR FILTRATION RATE. AN ANALYSIS FROM THE GISEA REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundIn real-life setting, a greater number of elderly rheumatoid arthritis (RA) patients with impaired glomerular filtration rate (GFR) needs treatment with biologic or target synthetic disease-modifying anti-rheumatic drugs (b/tsDMARD) to achieve disease control and reduce NSAIDs intake. Long-term observational data from the real-life on the use of b/tsDMARD in these patients are scarce.ObjectivesThe aim of this study was to evaluate the retention rate of b/tsDMARD in RA patients with impaired GFR in real-life setting.MethodsData of RA patients treated with at least one b/tsDMARD were retrospectively analyzed form the national Italian GISEA registry from January 2016 to December 2021. Estimated-GFR (eGFR) was calculated with the Cockcroft-Gault equation at the time of any b/tsDMARD prescription. For the purpose of this study, patients were divided in two groups, patients with impaired GFR (eGFR ≤60) and patients with normal GFR (eGFR >60). The retention rate was calculated by the Kaplan-Meier method and compared between these two groups by a log-rank test.ResultsThe study population included 2443 treatment-line with b/tsDMARD from 1888 patients (female 80.4%, age 57±12 years, mean baseline CDAI 17±12, FR/ACPA+ 69.5%) who started a new b/tsDMARD. Disease characteristics are shown in Table 1. 288 treatments with b/tsDMARD were started in patients with impaired eGFR and 2155 in patients with normal eGFR. Compared to patients with eGFR >60, patients with eGFR ≤60 showed higher HAQ-DI (1.3±0.8 vs 1±0.8, p<0.001) at the start of b/tsDMARD treatment. Glucocorticoids were more prescribed in patients with impaired eGFR (80.2% vs 72.8%, p<0.01), while csDMARDs were more prescribed in association with b/tsDMARD in patients with normal eGFR (83.1% vs 76.4%, p<0.01). Of note, CTLA4-Ig treatment was more prescribed in patients with impaired eGFR (26% vs 17.1%, p<0.05), while no difference in b/tsDMARD prescription was observed for other mechanism of actions. Drug survival was similar between RA patients with impaired eGFR [58.2%, mean survival time 35 months (CI95% 31-39)]and RA patients with normal eGFR [55%, mean survival time 34.4 months (CI95% 33-36), log rank: 0.88] (Figure 1). Cox regression model adjusted for age, sex and b/tsDMARD showed no impact of eGFR on drug survival [HR: 0.9 (CI95%: 0.7-1.2).ConclusionOur data show that impaired eGFR seems to not influence the persistence of b/tsDMARD treatment in RA patients.Disclosure of InterestsNone declared
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Grignaschi S, Xoxi B, Bozzalla Cassione E, Luvaro T, Greco MI, Mazzucchelli I, Bugatti S, Montecucco C, Manzo A. POS0561 PREVALENCE AND CHARACTERISTICS OF PATIENTS WITH “ARTHRALGIA AT-RISK” DEFINED ACCORDING TO THE RHEUMATOLOGIST AND THE NEW EULAR DEFINITION: A PILOT RETROSPECTIVE STUDY FOCUSSED ON REFERRAL TO A STRUCTURED EARLY ARTHRITIS CLINIC. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe phase preceding the development of rheumatoid arthritis (RA) may contain a novel window of opportunity for disease prevention and control. Investigation of this phase at population level remain, however, very challenging in epidemiological terms due to the rarity of the events. Patients seeking medical attention with arthralgia at-risk, defined by an expert rheumatologist (clinically suspect arthralgia, CSA) or by the recent EULAR definition represent an attractive platform for the identification of both seropositive and seronegative disease subsets.ObjectivesThe objective of this study was to explore the prevalence and characteristics of patients with different types of arthralgia, focusing on referral to the screening visit of an early arthritis clinic (EAC) as a putative enrichment strategy for pre-RA.MethodsEAC first referrals from January 1st 2019 to June 30th 2021 were systematically reviewed through a retrospective evaluation of medical charts. Patient’s history, comorbidities, PROs and clinical examination were recorded by two expert rheumatologists blind to immunological, ultrasound and radiological data. Arthralgia cases, sub-classified according to risk-definitions, were recorded. Categories at-risk, according to the rheumatologist’s opinion and the EULAR definition, were characterized and compared to other arthralgia cases for clinical characteristics, imaging data and autoantibody status.ResultsOf the 363 patients referred to the EAC, 178 were characterized by peripheral arthralgia (swollen joint count=0) at screening visit (49%). Of these patients, 130 cases were characterized by recent-onset arthralgia (ROA) (<12 months symptoms’ duration) (73% of the total). CSA, according to the rheumatologist’s opinion, was applicable to 71/178 total arthralgia patients (40%) and to 61/130 ROA patients (47%, recent-onset CSA, RO-CSA). Patients without CSA were characterized by undefined concomitant conditions or by “clinically suspect psoriatic or spondylarthritis arthralgia” (20/178, 11%). EULAR definition of arthralgia at-risk (>2 items) was fulfilled by 53/71 CSA patients (74.6%) and by 52/107 (49%) patients not characterized by CSA (p=0.001 Chi-square test) (Figure 1).Figure 1.Early Arthritis Clinic first referrals from January 1st 2019 to June 31th 2021.Despite a similar clinical phenotype, comparative analysis between different arthralgia categories demonstrated a significant enrichment of RF and ACPA positivity (21% vs 4%, p=0,001, and 15% vs 3%, p=0.01) in both CSA and RO-CSA vs other groups. RO-CSA showed also an enrichment of hypogammaglobulynemia compared to other groups (13% vs 3%, p=0.03). After a stratification according to the fulfillment of the EULAR definition, both CSA and RO-CSA increased their differences compared to other groups regarding the elevation of C-reactive protein (CRP ≥0.5 mg/dl, p=0.006 and p=0.02 respectively). No epidemiological, clinical or imaging differences were observed through patient stratification according to the EULAR definition per se in the whole population.ConclusionResults of our pilot study provide evidence of the applicability of patient selection according to current arthralgia at-risk definition in the real-life setting of an EAC. Both CSA and RO-CSA appears as suitable niches for the enrichment of primary immunological and serological risk factors for RA (RF/ACPA, hypogammaglobulynemia and C-reactive protein). Current data confirm in an independent setting the importance of the rheumatologist’s perspective as a platform for appropriate application of the EULAR definition.Disclosure of InterestsNone declared.
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Biglia A, Dourado E, Palterer B, Parronchi P, Pellico MR, Zanframundo G, Rivera Matias PA, Martins P, Miranda A, Cabral Da Fonseca JE, DI Agosta E, Cammelli D, Emmi G, Rosi E, Bixio R, Conticini E, Bellis E, Bruni C, Montecucco C, Matucci-Cerinic M, Rojas-Serrano J, Cavagna L. POS0863 ANTI-NOR90 ANTIBODIES IN THE SETTING OF CONNECTIVE TISSUE DISEASE: CLINICAL SIGNIFICANCE AND COMPARISON WITH A COHORT OF PATIENTS WITH SYSTEMIC SCLEROSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAnti-NOR90 antibodies are directed against a 90-kD nucleolar protein located in the nucleolus organizing regions (NORs), mainly described in systemic sclerosis (SSc) [1, 2, 3] but reported also in other rheumatologic and oncologic diseases [4, 5, 6]. The clinical correlates of anti-NOR90 antibodies are still to be defined because the cohorts described thus far include a low number of patients.ObjectivesTo describe the characteristics of a large cohort of anti-NOR90 antibodies positive patients and compare them with a matched cohort of SSc patients negative for anti-NOR90 antibodies.MethodsA retrospective analysis was performed on patients positive for anti-NOR90 antibodies referring to participating centres. The concomitant positivity for anti-RNA polymerase III, Th/To, PM-Scl, Ku, and PDGFR antibodies was an exclusion criterion. In all cases the diagnoses, the different organ involvement and related clinical, instrumental and laboratory characteristics were evaluated. The EUROLINE SystemicSclerosisProfile kit from Euroimmun (Lübeck, Germany) was used to detect anti-NOR90 antibodies.ResultsWe included 101 patients positive for anti-NOR90 (M/F=13/88, mean age 52.5 years). They were mainly classified as SSc (n=38), undifferentiated connective tissue disease (UCTD) (n=21), interstitial pneumonia with autoimmune features (IPAF) (n=11) (graph 1). The most frequent clinical manifestations were arthralgias (n=72), Raynaud’s phenomenon (RP) (n=58), sicca syndrome (n=49), ILD (n=40), puffy fingers (n=32), arthritis (n=30), and limited skin sclerosis (n=24). Anti-NOR90 antibodies were associated with anti-Ro52 antibodies in the 16% of cases, with anticentromere antibodies in the 7% of cases, and with anti-Scl70 in the 5% of cases. After excluding these patients, and considering the isolated anti-NOR90 positivity, 12 patients had SSc, 35 UCTD, and 11 IPAF. The most frequent clinical manifestations were arthralgias (n=40), RP (n=37), and sicca syndrome (n=21). Compared to 242 matched SSc without anti-NOR90 antibodies, patients with anti-NOR90 had more frequently joint manifestations and sicca syndrome and less frequently all vasculopathic manifestations (RP, telangiectasias, pitting scars, acral ulcers), dysphagia and fibromyalgia.ConclusionOur study shows that anti-NOR90 antibodies are more commonly observed in females, and clinically associated with the occurrence of arthritis/arthralgias, sicca syndrome and RP. In more than the 50% of cases they may be found with other autoantibodies, such as the anti-Ro52, the anticentromere, and the anti-Scl70 antibodies. Anti-NOR90 seems to play an accompanying role in the context of CTDs, without strong influence on the clinical phenotype expression of the underlying CTD.References[1]Rodriguez-Sanchez et al., Anti-NOR 90. A new autoantibody in scleroderma that recognizes a 90-kDa component of the nucleolus-organizing region of chromatin, 1987.[2]Hamaguchi et al., Clinical and immunologic predictors of scleroderma renal crisis in Japanese systemic sclerosis patients with anti-RNA polymerase III autoantibodies, 2015.[3]Liaskos et al., Disease-related autoantibody profile in patients with systemic sclerosis, 2017.[4]Imai et al., Immunocytochemical characterization of human NOR-90 (upstream binding factor) and associated antigens reactive with autoimmune sera. Two MR forms of NOR-90/hUBF autoantigens, 1994.[5]Fujii et al., Detection of autoantibodies to nucleolar transcription factor NOR 90/hUBF in sera of patients with rheumatic diseases, by recombinant autoantigen-based assays, 1996.[6]Yamashita et al., Clinical significance of anti-NOR90 antibodies in systemic sclerosis and idiopathic interstitial pneumonia, 2021.Figure 1.Disclosure of InterestsNone declared
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Bellis E, Codullo V, Palermo BL, Bottazzi F, Biglia A, Bellingeri C, Beneventi F, Spinillo A, Montecucco C, Zanframundo G, Cavagna L. POS0924 THE ROLE OF RAYNAUD’S PHENOMENON ON MATERNAL AND FETAL OBSTETRICAL OUTCOMES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIt is established that Raynaud’s phenomenon (RP) may influence pregnancy outcomes when secondary to rheumatic conditions (1,2). Data on the impact of primary RP (pRP) on pregnancy are very limited.ObjectivesTo retrospectively evaluate the impact of pRP on pregnancy outcomes.MethodsWomen with pRP were included in the study. They were compared with a group of women affected by UCTD with RP, and by UCTD without RP. These women were assessed and followed at our outpatient clinic from January 2011 to October 2020 and they did not exhibit an evolution to a UCTD or to a definite CTD during at least one-year follow-up. Antiphospholipid antibody positivity, twin pregnancies and voluntary termination of pregnancy were exclusion criteria. Women with pRP were also compared with a group of healthy pregnant women enrolled by our gynaecologist during the first trimester of pregnancy. Maternal and foetal outcomes were retrospectively recorded. ANOVA or the Kruskal-Wallis test for continuous variables, and the Chi2 test or the Fischer exact test for categorical were performed (level of significance. P<0.050). In the post-hoc analysis we used the Mann-Whitney test (quantitative variables) or with the Chi2 test/Fischer exact test (qualitative variables), applying the Bonferroni correction with pRP women as a reference group (level of significance: p<0.0167).ResultsThe analysis included 188 women with a total of 375 pregnancies divided in 4 groups:-Group “pRP”: 46 women with RP without secondary causes, and a total of 106 pregnancies (reference group),-Group “RP-UCTD”: 48 UCTD women with RP and a total of 88 pregnancies,-Group “UCTD”: 37 UCTD women without RP and a total of 88 pregnancies,-Group “HC”: 57 healthy women with a total of 93 pregnancies.The reference group did not differ from the others regarding age at conception.Prophylactic acetylsalicylic acid was administered during pregnancy to 9% of patients with pRP compared to 1% in HC (p=0.010). In contrast, in the RP-UCTD this percentage was significantly higher (32%, p<0,001) than in pRP.pRP group showed an increased rate of 1st trimester miscarriages (33% vs 16%, p=0.006, OR 2.05 and 95%CI 1.05-3.98), a lower median birth weights (3038 g vs 3358 g, p=0.002), a higher rate of infants with a birth weight <10th percentile (21% vs 3%, p=<0.001, OR 8.36 and 95% CI 1.85 - 37.84) with respect to HC. There was no statistically significant difference between the reference and the UCTD groups.No statistically significant differences were observed when considering obstetrical outcomes (eg: mode of delivery, median gestation duration, gestational diabetes mellitus, hypertensive disorder of pregnancy, premature rupture of membranes, oligo-anhydramnios).ConclusionOur study shows that pRP in a retrospective cohort has an impact on pregnancy outcomes, with significantly more miscarriages and lower birth weight infants compared to HC. Importantly, pregnancy outcome in pRP women did not differ with respect to UCTD with and without RP, conditions generally associated to maternal morbidity, but in the RP-UCTD group prophylactic acetylsalicylic acid was more commonly prescribed.Further prospective studies aiming at evaluating these differences and at identifying the appropriate follow-up and the possible benefit from the use of prophylactic acetylsalicylic acid during pregnancy in RP are necessary.References[1]Liu E et al. Arch Rheumatol., 2017.[2]Al Arfaj A et al. Lupus. 2010.Table 1.Analysis of obstetrical outcomesPrimary RP (pRP)RP-UCTDUCTDHCp-valueMiscarriagesN. (%)35 (33%)17 (19%)30 (31%)15 (16%)p=0,017vs pRPreferencep=0,051p=0,750p=0,006Median weight at birth(IQR), gr3038 (2710-3500)3180 (2935 - 3465)3157 (2910 - 3610)3358 (3195 - 3583)p=0,02vs pRPreferencep=0,3473p=0,1542p=0,0002Birthweight < 10th percentileN. (%)15 (21%)7 (10%)5 (8%)2 (3%)p=0,002vs pRPreferencep=0,087p=0,03p=<0,001Disclosure of InterestsNone declared
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De Stefano L, D’Onofrio B, Sakellariou G, Manzo A, Montecucco C, Bugatti S. POS0608 PROGRESSIVE INCREASE IN THE DIAGNOSTIC DELAY AND PERSISTENTLY SEVERE CLINICAL PRESENTATION OVER THE YEARS IN AUTOANTIBODY-NEGATIVE PATIENTS WITH RHEUMATOID ARTHRITIS IN THE SETTING OF AN EARLY ARTHRITIS CLINIC. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundOver the past 20 years, despite the widespread diffusion of dedicated early arthritis clinics (EAC) and more sensitive classification criteria, the percentage of patients seen within the window of opportunity remains low, and the new RA criteria, heavily weighted on autoantibodies, may have further hindered the recognition and treatment of seronegative patients.Objectiveswe analysed changes in the diagnostic delay and clinical presentation of patients with RA admitted to the EAC of the Division of Rheumatology of the San Matteo University Hospital, Pavia, Italy, from its institution in 2005 to 2017.MethodsReferral criteria to the EAC have remained stable over the years and include ≥3 swollen joints (SJs) or, in case of <3 SJs, a positive squeeze test or morning stiffness >30 min. From all early arthritis patients (n=1.553), we selected 668 patients fulfilling at enrolment at least the 1987 ACR criteria for RA before December 2010 (n=345, 88.4% also fulfilling 2010 criteria), and at least the 2010 ACR/EULAR criteria after January 2011 (n=323, 63.5% also fulfilling 1987 criteria). Time from first self-reported joint symptom to referral (diagnostic delay) was compared across different time periods: (i) 2005-2007; (ii) 2008-2010; (iii) 2011-2013; (iv) 2014-2017. Clinical characteristics were collected according to standardised assessments. Data were analysed in the total population and after stratification for the autoantibody status (double negative for rheumatoid factor, RF, and anti-citrullinated protein antibodies, ACPA vs RF and/or ACPA positive).ResultsIn all, the diagnostic delay collectively increased from a mean (SD) of 20.8 (20.5) weeks before 2010 to 24.4 (20.6) weeks thereafter (p=0.02), and the proportion of patients diagnosed within 12 weeks non-significantly decreased from 39.3% to 35.3%. Still, patients presented with progressively milder inflammatory markers despite unchanged joint tenderness and patient-reported outcomes (PROs). Trends were, however, remarkably different in different autoantibody subgroups. In RF/ACPA-positive patients, a stable proportion of 41-44% was diagnosed within 12 weeks (Figure 1A). At presentation, patients had fewer SJs and lower C-reactive protein (CRP) levels; the mean decrease of SJs and CRP from 2005-2007 to 2014-2017 were -5.6 and -1.1 mg/dl, respectively (Figure 1B). The improvement in PROs was smaller but still significant over time (Figure 1C). In contrast, in autoantibody-negative patients, the proportion of patients diagnosed within 12 weeks progressively decreased from 37.9% to 25.6% (p=0.08) (Figure 1D). Furthermore, the improvement over time of inflammatory features, especially of SJs, was significant but smaller than autoantibody-patients, and PROs such as pain and global assessment of disease activity remained severely impacting with mean values of up 60 mm even in recent times (Figure 1E,F).Figure 1.Time to diagnosis and clinical presentation of autoantibody-positive and –negative patients with early rheumatoid arthritis. (A, D) Proportion of patients diagnosed within 12 weeks from symptoms’ onset among autoantibody-positive (A) and autoantibody-negative (D) rheumatoid arthritis (RA) in different time periods. (B, C, E, F) Values of swollen joints (SJC28), C-reactive protein (CRP) (B, E), and visual analogue scales (VAS) for pain and patient global assessment (PGA) of disease activity (C, F) in autoantibody-positive (B, C) and autoantibody-negative (E, F) RA in different time periods. Values are expressed as means and standard errors.ConclusionCollectively, our data indicate that a large proportion of patients with RA still lack early diagnosis despite dedicated early access to rheumatology care; from 2010 onwards, autoantibody-positive patients are diagnosed with a milder and less disabling disease, while autoantibody-negative patients are at increased risk of delayed diagnosis, and remain burdened with severe diseaseDisclosure of InterestsLudovico De Stefano Speakers bureau: Gilead, Bernardo D’Onofrio: None declared, Garifallia Sakellariou: None declared, Antonio Manzo: None declared, Carlomaurizio Montecucco Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, Pfizer, Roche, Sanofi, Serena Bugatti Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, Gilead, Pfizer, Sanofi, Grant/research support from: Pfizer
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Abouyahya I, Liem S, Amoura Z, Fonseca JE, Chaigne B, Cutolo M, Doria A, Fischer-Betz R, Guimaraes V, Hachulla E, Huizinga T, van Laar JM, Martin T, Matucci-Cerinic M, Montecucco C, Schneider M, Smith V, Tincani A, Müller-Ladner U, de Vries-Bouwstra J. AB0675 Health related quality of life in patients with mixed connective tissue disease: A comparison with matched systemic sclerosis patients. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMixed connective tissue disease (MCTD) is a systemic auto-immune disorder, being probably the least common among the connective tissue diseases. Symptoms can be severe and could affect health-related quality of life (HRQoL). Identification of the burden of MCTD patients is of key importance to provide appropriate pharmacological and non-pharmacological care. No reports on HRQoL have been published in adult patients with MCTD.ObjectivesTo perform an explorative study to evaluate HRQoL and its main determinants in MCTD patients, and compare HRQoL between MCTD and matched systemic sclerosis (SSc) patients.MethodsMCTD patients fulfilling the Kahn criteria and participating in the MCTD prospective follow-up cohort of the Leiden University Medical Center were included. In addition, SSc patients matched for age, gender and disease duration were included for comparison. Data on disease characteristics, functional disability and HRQoL were collected annually for both disease groups. HRQoL was evaluated using the 36-Item Short Form Health Survey (SF36) and EuroQol (EQ5D). At baseline, HRQoL, as reflected by SF36 mental component score (MCS), SF 36 physical component score (PCS) and EQ5D were compared between MCTD and SSc patients. For MCTD patients, factors associated with HRQoL at baseline were identified using linear regression and change in HRQoL over 3 years was evaluated using linear mixed models. In addition, characteristics of MCTD patients who showed worsening of MCS and/or had PCS superior to the minimal clinical important difference of three points were identified.ResultsThirty-four MCTD patients (121 visits; 82% female, mean age 42 years, median disease duration 45 months) and 102 SSc patients (424 visits; 82% female, mean age 45 years, median disease duration 49 months) were included. At baseline, MCTD-patients more often had ILD (47% vs. 34%, p=0.027), cardiac involvement (30% vs. 2%, p<0.001), synovitis (26% vs. 11%, p=0.004) and myositis (15% vs. 1%, p=0.001) compared to SSc patients, whereas SSc patients more often used immunosuppressive treatments except for hydroxychloroquine (MCTD:18% vs. SSc:7%, p=0.007).Baseline HRQoL in MCTD was comparable to HRQoL in SSc, with mean SF36-PCS of 40.2 (SD:9.1) and mean SF36-MCS of 44.9 (SD:9.9), which is (nearly) one standard deviation lower than the general Dutch population. The SF36 subscore “general health perception” was the most impacted in both groups (MCTD: 38.5 [SD:7.0], SSc: 39.9 [SD:8.9]). The median EQ5DNL was 0.38 (IQR:0.14 – 0.54) and comparable between SSc and MCTD.At baseline, in MCTD, ILD was significantly associated with SF36-PCS (β:6.98, 95% CI: 1.10 to 12.86) and SF36-MCS (β:-8.10, 95% CI:-14.93 to -1.26). Sclerodactyly was significantly associated with EQ5DNL (β:0.006; 95% CI:0.002 to 0.010) and SF36-PCS (β:0.12, 95% CI:0.03 to 0.21). No other significant associations were identified.Over time, in MCTD, both the SF36-MCS and SF36-PCS improved significantly (MCS: β:2.35/year [95% CI:0.58 to 4.13], PCS: β:1.34/year [95% CI:0.03 to 2.65), whereas EQ5DNL was stable. Explorative analyses did not reveal a specific clinical characteristic with significant impact on the change of HRQoL over time. With an MCID of 3 points on the MCS and PCS, 7 MCTD-patients worsened on the MCS and 3 on the PCS. Patients who showed worsening of MCS over time tended to be older, more often had ILD, sclerodactyly and GI complaints, and had worse exercise tolerance. All these differences did not reach statistical significance. The patients who decreased PCS more often had ILD (100% vs. 41%, p=0.015), and used glucocorticoids more often (33% vs. 0%, p=0.046), were slightly older and had a worse exercise tolerance as compared to those who showed a stable/improving PCS over time.ConclusionLike in SSc, HRQoL is significantly impaired in MCTD, especially the general health perception of patients. Cardiac involvement, ILD, age and worse functional disability might specifically impact HRQoL in MCTD. However, these associations need further evaluations in larger cohorts.Disclosure of InterestsNone declared
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DI Cola I, DI Muzio C, Conforti A, Iacono D, Pantano I, Rozza G, Rossi S, De Stefano L, Vitale A, Caso F, Costa L, Prete M, Navarini L, Sensini F, Iagnocco A, Atzeni F, Guggino G, Perosa F, Cantarini L, Frediani B, Bugatti S, Montecucco C, Ciccia F, Giacomelli R, Cipriani P, Ruscitti P. POS1337 ADULT-ONSET STILL’S DISEASE WITH ELDERLY ONSET, RESULTS FROM A MULTICENTRE STUDY AND ASSESSMENT OF AGE INFLUENCE ON CLINICAL FEATURES AND DISEASE OUTCOMES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAging is a physiological, multidimensional, and irreversible process, occurring in humans over time. Interestingly, multiple lines of evidence have recently suggested that some diseases, generally affecting young adults, are nowadays described in the elderly, although possibly associated with different symptoms or complications. In this context, a possible occurrence of adult onset Still’s disease (AOSD) in elderly has been suggested. This is a rare inflammatory disorder of unknown origin usually observed in young adults [1-3].ObjectivesIn this study, we aimed at describing the clinical characteristics, life-threatening complications occurrence, and mortality of AOSD patients with an elderly onset. The manifestations of these patients were also compared with those with a younger onset. Furthermore, the predictive role of age was evaluated on clinical features and disease outcomes. Finally, in these patients, an assessment of associated comorbidities was also performed.MethodsA retrospective assessment of prospectively followed patients, from January 2001 to April 2021, was provided to analyse clinical features, life-threatening complications occurrence, and mortality in AOSD patients with onset in elderly. AOSD patients, who were included in multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort, were evaluated.ResultsOut of 221 assessed patients, 37 (16.7%) had an onset of the disease aged over than 60 years. When compared with younger patients, these were characterised by a higher prevalence of pericarditis (p=0.008), comorbidities (p<0.0001), and mortality (p=0.023).Additionally, our analysis showed that pleuritis and pericarditis positively correlated with age (coefficient=0.227, p=0.001; coefficient=0.213, p=0.001, respectively). Furthermore, the occurrence of parenchymal lung disease was significantly related with age (coefficient=0.168, p=0.012). The presence of comorbidities positively correlated with age (coefficient=0.443, p<0.0001). Moreover, age was negatively related to the polycyclic pattern (coefficient=-0.209, p=0.002). A correlation between mortality and age was also retrieved (coefficient=0.158, p=0.019).Age predicted the presence of serositis in both univariate (HR: 1.02, 95%CI: 1.01-1.03, p=0.007) and multivariate analyses (HR: 1.02, 95%CI: 1.01-1.04, p=0.007). Age was also a significant predictor of parenchymal lung disease in both univariate (HR: 1.03, 95%CI: 1.01-1.05, p=0.017) and multivariate analyses (HR: 1.03, 95%CI: 1.00-1.05, p=0.048). No significant results were observed assessing the predictive role of age on occurrence of macrophage activation syndrome. Furthermore, age resulted to be a negative predictor of polycyclic pattern only in univariate analysis (HR: 0.99, 95%CI: 0.97-1.00, p=0.048). Finally, age significantly predicted the mortality in both univariate (HR: 1.03, 95%CI: 1.00-1.06, p=0.034) and multivariate analyses (HR: 1.05, 95%CI: 1.01-1.08, p=0.012).ConclusionClinical features of AOSD patients with elderly onset were described in our multicentre cohort. Although the main clinical characteristics were similar comparing older and younger patients, patients aged over 60 years at disease onset were characterised by an increased prevalence of serositis, comorbidities, mostly cardiometabolic, and a higher mortality rate. Age predicted the presence of parenchymal lung disease and mortality, and it could be considered a further negative prognostic factor in AOSD.References[1]Mollaeian A, Chen J, et al. BMC Rheumatol. 2021;5(1):12.[2]Maruyama A, et al. Mod Rheumatol. 2021;31(4):862-868.[3]Suzuki E, et al. Tohoku J Exp Med. 2021;255(3):195-202.Disclosure of InterestsNone declared
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Bartoletti A, Franchi G, Fornara C, Delvino P, Baldanti F, Lilleri D, Montecucco C, Monti S. POS0275 SEROLOGICAL RESPONSE FOLLOWING THREE DOSES OF SARS-CoV-2 mRNA VACCINE IN PATIENTS WITH GIANT CELL ARTERITIS: EXPERIENCE OF A SINGLE-CENTRE COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe spread of COVID-19 pandemic raised the need to perform an additional vaccine dose to overcome the diffusion of the infection and possible life-threatening disease complications. Certain population subsets seem to be at increased risk of developing such complications, such as elderly and/or immunocompromised patients.ObjectivesTo assess the persistence of immunity following SARS-CoV-2 mRNA vaccine and the magnitude of the humoral response after the booster dose in a cohort of patients affected by giant cell arteritis (GCA).MethodsPatients with GCA regularly followed at the Rheumatology Department of the University of Pavia, Italy, who received a booster dose of SARS-CoV-2 mRNA vaccine (BNT162b2 Pfizer/BioNtech or mRNA-1273 Moderna) between October 1st and December 31st, 2021 were included. Humoral response was assessed by measuring SARS-CoV-2 Trimeric S (TSAbs) and Neutralizing (NAbs) antibodies, with a cut-off of 33.8 Binding Antibody Units (BAU)/mL and 1:10 dilution, respectively. Blood samples from each patient were drawn at least 4 months after the second and three weeks after the third vaccine dose.ResultsForty-two patients who received the booster dose of SARS-CoV-2 mRNA vaccine were enrolled. Thirty (71.4%) were females, mean age 73.2±4.7 years, disease duration 58±38 months, 19 (45.2%) had large-vessel vasculitis. Thirty-two (76.2%) were on glucocorticoids (GCs) at a mean dose of 4.9±7.8 mg/day prednisone equivalent, with 7 (16.7%) receiving ≥7.5 mg/day. Eighteen (42.9%) were on methotrexate (MTX) (mean dose 14.2±3.5 mg/week) and 8 (19.0%) were treated with subcutaneous tocilizumab (TCZ) 162 mg/week.SARS-CoV-2 serology was tested prior to the third vaccine dose at an average of 5.4±0.4 months from the former vaccination scheduled: 37 (88.1%) retained TSAbs and 30 (71.4%) NAbs. The median TSAb titre was 134 BAU/mL (IQR 97-292). Four out of 5 patients (80.0%) without TSAbs and 7 out of 12 (58.3%) without NAbs were on both GCs and MTX. Moreover, those on GCs plus MTX had lower pre-third dose TSAb titres as compared to other treatment subgroups (Figure 1A). GC doses ≥7.5 mg/day prednisone equivalents seemed to blunt NAb levels along time: 28.6% patients on GCs ≥7.5 mg/day prednisone equivalents had negative NAbs before the third dose vs. 80.0% of those taking <7.5 mg/day (p=0.007) as well as lower NAb titres (Figure 1B).Figure 1.(A) TSAb levels before and after the booster dose among patients on GC + MTX. (B) NAb titres before and after the booster dose according to treatment with prednisone ≥7.5 mg/day or (C) MTX in combination with GCs or (D) MTX alone.Data regarding antibody response after the booster dose were available for 35 patients (83.3%). Blood collection occurred at a median of 25 days (IQR 24-32) after the third vaccine dose. All patients developed TSAbs, even those who did not respond to the previous shots. The median TSAb titre rose to 2080 BAU/mL (IQR 2080-2080) (p<0.001), while the median NAb titre increased from 1:10 to 1:320 (p<0.001). One patient (2.9%) treated with prednisone 8.75 mg/day plus MTX 12.5 mg/week did not develop NAbs. NAb levels were lower in patients taking MTX as compared to those who did not (Figure 1C,D), whereas treatment with TCZ or GCs, along with the GC dose, did not affect the magnitude of the antibody response.There were no serious adverse events from the vaccine. However, 3 patients (8.6%) experienced a disease relapse 24±5 days after the booster dose.ConclusionIn our cohort, most patients who seroconverted after the second dose of vaccine retained the humoral immunity, with excellent seroconversion rates following the booster dose. However, GCs, especially at doses ≥7.5 mg/day prednisone equivalents, may contribute to the waning of NAb titres. On the other hand, immunosuppressants like MTX, especially when combined with GCs, might impair the magnitude of the humoral response to the booster dose.Disclosure of InterestsNone declared
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Campaniello D, Treppo E, D’onofrio B, Franchi G, Berti A, Iorio L, Bortolotti R, Montecucco C, Monti S, Quartuccio L, Doria A, Schiavon F, Padoan R. POS0837 EFFICACY OF ULTRA-LOW DOSE RITUXIMAB FOR REMISSION MAINTENANCE THERAPY IN ANCA-ASSOCIATED VASCULITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundRituximab (RTX) achieved high remission-induction and sustained maintenance rates for patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) [1], [2]. However, RTX is an expensive medication, which may potentially lead to serious side effects. Defining the best dose regimen for maintenance in AAV is still an unmet need.ObjectivesThe aim of the present study is to compare the effects of ultra-low dose RTX (500 mg or 1000 mg once per year) to standard low dose RTX (500 or 1000 mg twice per year) as remission-maintenance therapy in AAV patients.MethodsWe included consecutive AAV patients (classified as GPA and MPA [3]) referring to four different Rheumatology centers in Italy. We assessed all AAV patients who successfully achieved disease remission (BVASv3=0) with conventional RTX or cyclophosphamide regimens and have been subsequently treated with RTX for maintenance of remission. All included patients received at least three maintenance infusions with either 1000 mg or 500 mg, twice per year (standard low dose) or once per year (ultra-low dose). After a period of 18 months, we assessed the remission rate, damage (VDI), glucocorticoids intake, ANCA status, B-cells depletion and serum IgG levels.ResultsFrom January 2011 to December 2021, 83 AAV patients (mean age 51±16, 49.4% female, 95.2% ANCA positive, 65.8% anti PR3, 34.2% anti MPO), 61 classified as GPA and 22 MPA, achieved complete disease remission with conventional RTX induction regimen. After 7 [6-9] months, 29.9% patients started maintenance treatment with ultra-low dose RTX (once per year), while 70.1% patients with standard low dose (twice per year), for 18 months. No significant differences at baseline were noted between patients receiving ultra-low dose when compared to those treated with conventional low-dose.At the end of observation period, a disease flare was observed in 22.7% of the low-dose group, and 21.2% in those treated with the standard dose (p=0.881). Relapse-free survival was comparable between the two group (log-rank p=0.818, Figure 1).Figure 1.When comparing AAV patients treated with ultra-low dose regimen to those treated with low-dose, no differences were noted in negative ANCA rate (72.2% vs 67.1%, p=0.262), ANCA titer (0 [0-7.8] vs 0 [0-50] UI/mL, p=0.232), B-cells depletion rate (70.6% vs 75%, p=0.725), mean serum IgG (811 [146-922] vs 680 [429-861] mg/dL, p=0.367), mean daily glucocorticoid dosage (2.5 [0-5] vs 3.75 [0-5] mg/d, p=0.647), VDI (4 [1-5] vs 2 [1-4], p=0.098), hypogammaglobulinaemia rate (31.8% vs 36.5%, p=0.697) and deaths (4.5% vs 5.8%, p=0.831).Although not significant, patients treated with ultra-low dose had lower severe infection rate (10.5% vs 26.8%, p=0.154). Notably, in the all cohort 5 deaths were related to COVID19 pneumonia.ConclusionReduced exposure to RTX was not associated with an impaired efficacy of maintenance therapy in patients with AAV. Remission maintenance with ultra-low dose RTX is a safe and more cost-effective option.References[1]B. Terrier et al., “ANCA-associated vasculitides: Recommendations of the French Vasculitis Study Group on the use of immunosuppressants and biotherapies for remission induction and maintenance,” Press. Medicale, vol. 49, no. 3, 2020, doi: 10.1016/j.lpm.2020.104031.[2]S. V. Moiseev, N. M. Bulanov, A. S. Zykova, and P. I. Novikov, “Rituximab in ANCA-associated vasculitis: Fewer infusions or ultra low-dose maintenance therapy,” Ann. Rheum. Dis., vol. 78, no. 9, pp. 1–2, 2019, doi: 10.1136/annrheumdis-2018-213873.[3]J. C. Jennette et al., “2012 Revised International Chapel Hill consensus conference nomenclature of vasculitides,” Arthritis Rheum., vol. 65, no. 1, pp. 1–11, 2013, doi: 10.1002/art.37715.Disclosure of InterestsNone declared
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Andreoli L, Gerardi MC, Crisafulli F, Zanetti A, Rozza D, Gerosa M, Lini D, Filippini M, Fredi M, Nalli C, Lazzaroni MG, Taglietti M, Franceschini F, Caporali R, Trespidi L, Erra R, Mosca M, Tani C, Zucchi D, Melissa P, Ruffilli F, Maranini B, Rovere-Querini P, Canti V, De Lorenzo R, Cutro MS, Picerno V, Montecucco C, Ramoni V, Anelli MG, Abbruzzese A, Serale F, Romeo N, Chimenti MS, Cuomo G, Larosa M, Pata AP, Iuliano A, Crepaldi G, Brucato A, Landolfi G, Carrara G, Bortoluzzi A, Scirè CA, Tincani A. OP0125 THE MANAGEMENT OF PREGNANCY IN AUTOIMMUNE RHEUMATIC DISEASES: ANALYSIS OF 758 PREGNANCIES FROM THE PROSPECTIVE NATIONWIDE P-RHEUM.IT STUDY (THE ITALIAN REGISTRY OF PREGNANCY IN THE RHEUMATIC DISEASES). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPregnancy is a topic of fundamental importance for women living with autoimmune rheumatic diseases (ARD). Efforts at national and international levels have been put in the collection and harmonization of data in order to implement an evidence-based management of pregnant patients.ObjectivesThe P-RHEUM.it study was designed as a nationwide, web-based longitudinal observational cohort study to collect data about pregnancy in ARD in 26 centers in Italy. The study started in May 2018 and has been supported by the Italian Society for Rheumatology.MethodsPregnant patients with a definite rheumatic disease according international criteria were enrolled up to gestational week (GW) 20. The course of maternal disease activity, the use of medications, fetal and maternal complications, and the quality of life (EuroQoL questionnaire) were collected for each trimester, as well as pregnancy outcome, mode of delivery, neonatal complications, and maternal and children’s follow-up to 6 months after delivery, including the screening for post-partum depression by means of EPDS (Edinburgh Postnatal Depression Scale).ResultsAs of December 2021, 758 pregnancies had been enrolled, 205 (27%) ongoing and 553 (73%) with outcome. Pregnancy loss occurred in 54 (9.8%) cases (40 spontaneous miscarriages; 6 voluntary terminations). Live births were 495 (89.5%), perinatal death occurred in 4 (0.7%) cases. Table 1 reports on the group of 495 live births, along with subgroups of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE), the two most represented diseases. Regarding treatments, 166 (30%) pregnancies were exposed to corticosteroids, 239 (43%) to hydroxychloroquine, 59 (10.7%) to csDMARDs, 84 (15.2%) to TNF inhibitors, 1 (0.2%) to non-TNFi bDMARDs, 299 (54%) to low dose acetylsalicylic acid, and 126 (22.8%) to heparin.Table 1.PREGNANCIES WITH LIVE BIRTHS, EXCLUDING PERINATAL DEATHSTotal pregnancies (n=495)RA pregnancies (n=69)SLE pregnancies (n=93)Age at conception (years)34 (31 - 37)34.5 (32 - 38)34 (31 - 36)Disease duration (years)6.1 (2.2 - 11.1)7.1 (4.3 - 11.6)9.3 (5.9 - 15.9)Caucasian431 (87.8%)53 (79.1%)75 (80.6%)Never smokers358 (73.8%)53 (80.3%)66 (71.7%)Body Mass Index >3045 (9.5%)7 (10.3%)5 (5.6%)Arterial Hypertension6 (1.2%)0 (0%)2 (2.2%)Time to pregnancy (months)3 (1 - 6)3 (1 - 6)3 (0 - 10)Physician-reported flares in the 12 months prior to conception107 (23%)22 (34.4%)13 (14.8%)Physician global assessment at enrolment (VAS 0-100)5 (0 - 17)5 (0 - 20)4 (0 - 10)Patient global health at enrolment (VAS 0-100)18 (7 - 30)10 (5 - 29)10 (5 - 25)EuroQoL at enrolment (-1.6 – 1)1 (0.8 - 1)1 (0.8 - 1)1 (0.8 - 1)Flares during pregnancy35 (7.1%)6 (8.7%)7 (7.5%)Hypertensive disturbances*8 (1.7%)1 (1.6%)6 (6.6%)Delivery at term (≥37 GW)410 (85.1%)53 (77.9%)74 (80.4%)Spontaneous vaginal delivery173 (35.9%)23 (33.8%)23 (25.3%)Congenital malformations11 (2.4%)2 (3.1%)1 (1.1%)Small for gestational age (SGA) neonate24 (4.9%)1 (1.4%)9 (9.9%)Breastfeeding in the first 4 weeks after delivery341 (79.7%)45 (77.6%)59 (76.6%)EPDS score at risk for post-partum depression22 (14.1%)0 (0%)3 (10.3%)Continuous variables are expressed as median (interquartile range); *gestational hypertension/preeclampsia/HELLP syndrome/eclampsia.ConclusionMultiple factors may have contributed to the high rate of live births, including good disease control before and during pregnancy thanks to the use of anti-rheumatic drugs and low frequency of general risk factors. SLE pregnancy was affected by a higher frequency of complications (hypertensive disturbances, SGA babies) as compared to RA pregnancy. Nearly 80% of patients breastfed in the first month after delivery. For the first time, data about the screening questionnaire for post-partum depression were collected, showing at least 1 out 10 patients can be at risk.References[1]Meissner Y et al. Arthritis Res Ther;21(1):241; Ann Rheum Dis. 2021;80(1):49-56.AcknowledgementsP-RHEUM.it study is supported by the Italian Society for Rheumatology (SIR). All the Investigators are acknowledged for their contribution.Disclosure of InterestsNone declared
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Ruscitti P, Ursini F, Berardicurti O, Masedu F, Bozzalla Cassione E, Naldi S, DI Cola I, DI Muzio C, De Stefano L, DI Nino E, Sensini F, Navarini L, Vomero M, Bugatti S, Valenti M, Mariani E, Iagnocco A, Montecucco C, Giacomelli R, Cipriani P. OP0044 CYTOKINE PROFILE, HYPERFERRITINEMIA, AND MULTI-VISCERAL INVOLVEMENT CHARACTERISE MACROPHAGE ACTIVATION SYNDROME COMPLICATING ADULT ONSET STILL’S DISEASE. RESULTS FROM A MULTIDIMENSIONAL EVALUATION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAdult-onset Still’s disease (AOSD) is a rare multigenic autoinflammatory disease of unknown aetiology burdened by life-threatening, such as macrophage activation syndrome (MAS) [1]. Considering the poor outcome of MAS patients, previous works tried to assess predictive factors of its occurrence during AOSD [2-4]. However, an integrated evaluation of clinical features with biomolecules, more reflecting the pathogenic mechanisms of the disease and its complications, is still missing.ObjectivesTo multidimensionally characterise MAS complicating AOSD considering cytokine profile, inflammatory markers, and multi-visceral involvement of the disease. To perform a high-dimensional phenotypic analysis of circulating immune cells in AOSD patients with and without MAS. To assess interferon (IFN)-related pathways in AOSD synovial tissues by a bulky RNA sequencing.MethodsThe present evaluation was designed to multidimensionally compare AOSD patients with or without MAS, considering cytokine profile, inflammatory markers, and multi-visceral involvement of the disease. Clinical and biologic data were collected and compared in AOSD patients with and without MAS. Sera biomolecules were analysed by Luminex multiplexing technology. Mass cytometry (CyTOF) was used to characterise circulating immune cells. A bulky RNA sequencing was performed in AOSD synovial tissues.ResultsIn this study, 40 consecutive AOSD patients (47.7±15.0 years, 50.0% male gender) were assessed at the time of diagnosis before the administration of any immunosuppressive therapy. Out of those, 14 (35%) patients were complicated by MAS. Paralleling with increases of systemic score and ferritin, MAS patients were characterised by an increased concentration of IL-1α, IL-1β, IL-1Ra, IL-2Ra, IL-6, IL-10, IL-17A, IFN-γ, G-CSF, MCP-1, MIP-1α, SCF. Among these biomolecules, IL-1Ra, IFN-γ, MCP-1, and SCF were correlated with MAS.Combining the discriminatory ability of these data in identifying MAS, the best model was composed by systemic score, ferritin, IFN-γ, and IL-10. This model was characterised by AUC=0.99 (Standard error: 0.008; 95%CI: 0.976–1.000), sensitivity=100%, specificity=95.45%. By CyTOF analysis, AOSD patients, who were complicated or not with MAS were characterised by a significant increase of circulating “classical monocytes” (CD14+CD38+). MAS patients were characterised by a significant reduction of NK cells (CD45RA+CD56dim) than AOSD patients. Finally, the transcriptomic profile, by RNA-sequencing analysis, showed that 3477 among type I, II, and III IFN-related genes (IRGs) were significantly different in AOSD synovial tissues.ConclusionA multidimensional characterisation of AOSD patients was provided suggesting that IFN-γ, IL-10, ferritin, and systemic score discriminated MAS, thus identifying the occurrence of the cytokine storm syndrome. The inflammatory milieu of AOSD and MAS may be associated with a signature of circulating immune cells. Finally, our results about IRGs reinforced the role of IFN-γ in these patients.References[1]Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still’s disease. J Autoimmun. 2018;93:24-36.[2]Ruscitti P, et al. Macrophage Activation Syndrome in Patients Affected by Adult-onset Still Disease: Analysis of Survival Rates and Predictive Factors in the Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale Cohort. J Rheumatol. 2018;45:864-872.[3]Di Benedetto P, et al. Ferritin and C-reactive protein are predictive biomarkers of mortality and macrophage activation syndrome in adult onset Still’s disease. Analysis of the multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort. PLoS One. 2020;15:e0235326.[4]Wan L, et al. Total metabolic lesion volume of lymph nodes measured by 18F-FDG PET/CT: a new predictor of macrophage activation syndrome in adult-onset Still’s disease. Arthritis Res Ther. 2021;23:97.Disclosure of InterestsNone declared.
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Biglia A, Bozzalla Cassione E, Zanframundo G, Cavagna L, Morandi V, Bobbio Pallavicini F, Valentini A, Cavenaghi G, Montecucco C. Pulmonary nocardiosis in a patient affected by anti-MDA5-positive amyopathic dermatomyositis under immunosuppressive therapy. Scand J Rheumatol 2021; 51:164-165. [PMID: 34643167 DOI: 10.1080/03009742.2021.1972518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Biglia
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - E Bozzalla Cassione
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - G Zanframundo
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - L Cavagna
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - V Morandi
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - F Bobbio Pallavicini
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - A Valentini
- Radiology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - G Cavenaghi
- Nuclear Medicine Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - C Montecucco
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
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Ponte C, Monti S, Scirè CA, Delvino P, Khmelinskii N, Milanesi A, Teixeira V, Brandolino F, Diamantino Saraiva FM, Montecucco C, Fonseca JE, Schmidt WA, Luqmani R. OP0055 ULTRASOUND HALO SIGN AS A POTENTIAL MONITORING TOOL FOR PATIENTS WITH GIANT CELL ARTERITIS: A PROSPECTIVE ANALYSIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Ultrasound of the temporal ± axillary arteries showing a non-compressible halo sign is recommended for diagnosing patients with giant cell arteritis (GCA); however, its value for monitoring disease activity is still poorly understood.Objectives:To assess the sensitivity to change of ultrasound halo features and their association with disease activity and glucocorticoid (GC) treatment in patients with newly diagnosed GCA.Methods:Two centre prospective study of new patients with ultrasound confirmed-GCA who underwent serial ultrasound assessments of the temporal (TA) and axillary (AX) arteries at fixed time-points. The number of arterial segments with halo and the maximum halo intima-media thickness (IMT) per segment was recorded at each visit. Only time-points in which >80% of patients were assessed were considered for analysis. Sensitivity to change of the halo sign was calculated as standardised mean difference (SMD) for each time-point separately. Correlation between ultrasound findings and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Birmingham Vasculitis Activity Score (BVAS), and GC treatment was performed using Spearman’s correlation coefficient. Logistic regression was used to determine the probability of being in remission for each unit increase (standardised) of the halo feature of interest. Remission was defined as the absence of relapse with a prednisolone dose <30 mg/day, and relapse as the recurrence of GCA-related symptoms or rise of CRP/ESR values not otherwise explained and requiring GC increase. Halo features at disease onset and first relapse were compared using Wilcoxon test.Results:A total of 49 patients (73.5% females) with a mean age of 78.2 ± 7.4 years at baseline were assessed at 354 visits. TA involvement was reported in 47 (95.9%) patients and AX involvement in 11 (22.4%); 220 arterial segments with halo were recorded (201 TA, 19 AX). Halo sensitivity to change was calculated for weeks 1, 3, 6, 12 and 24, and showed a significant SMD between all time-points and baseline for the TA halo features, but only after week 6 for the AX halo features (Table and Figure). The number of TA segments with halo, sum of TA halo IMT and maximum TA halo IMT showed a significant correlation with ESR (0.41; 0.44; 0.48), CRP (0.34; 0.39; 0.41), BVAS (0.29; 0.36; 0.35) and GC cumulative dose (-0.34; -0.37; -0.32). The likelihood of achieving disease remission was lower in patients with a higher number of TA segments with halo (OR 0.39, p<0.05) and increased values of sum and maximum TA halo IMT (OR 0.34, p<0.05). By contrast, AX halo features showed no correlation with disease activity, nor any association with attaining clinical remission. During the study period, 32 relapses were observed (mean time for first relapse of 31.8 weeks ± 18.5 days). Halo sign was present in 16/17 (94.1%) cases of first disease relapse, all showing an increased halo IMT (sum and maximum) in relation to the previous ultrasound assessment performed. When compared to disease onset, a lower mean number of segments with halo and mean sum of halo IMT was reported for patients presenting with their first clinical relapse (2.93 ± 1.59 vs. 4.85 ± 1.51, p=0.0012; 2.01 ± 1.13 vs. 4.49 ± 1.95 mm, p=0.0012).Table 1.SMD of halo features between baseline and different time-pointsWeek 1Week 3Week 6Week 12Week 24N of arterial segmentsSum of all segments with halo (n=49)-0.51-0.78-1.13-1.69-1.52Sum of TA segments with halo (n=47)-0.49-0.78-1.18-1.87-1.69Sum of AX segments with halo (n=11)-0.35--0.62-0.73-0.91Halo thickness (mm)Sum of all halo IMT (n=49)-0.98-1.44-1.37-1.60-1.48Sum of TA halo IMT (n=47)-1.01-1.55-1.54-1.81-1.69Sum of AX halo IMT (n=11)-0.15-0.45-0.81-0.84-0.98Max. TA halo IMT (n=47)-1.07-1.32-1.47-1.91-2.19Max. AX halo IMT (n=11)-0.04-0.29-0.94-1.13-1.01In bold p<0.05; n=n at baselineConclusion:Ultrasound is a reliable imaging tool to assess disease activity and response to treatment in patients with GCA. Future clinical trials in GCA should evaluate direct treatment effect on halo features as an outcome measure of interest.Acknowledgements:The first two authors contributed equally to this workDisclosure of Interests:None declared
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Zanframundo G, Bozzini S, Codullo V, Frangipane V, Pandolfi L, Atienza-Mateo B, Remuzgo Martinez S, Montecucco C, González-Gay MA, Meloni F, Cavagna L. POS0426 CIRCULATING MICRORNA PROFILING IN PATIENTS WITH ANTI-SYNTHETASE SYNDROME AND INTERSTITIAL LUNG DISEASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Anti-synthetase syndrome (ASSD) is an autoimmune disease characterized by autoantibodies against one of many aminoacyl transfer RNA (tRNA) synthetases. Interstitial Lung Disease (ILD) in ASSD patients is frequent, often severe and rapidly progressive, causing much of the increased morbidity and mortality associated with ASSD as compared to other idiopathic inflammatory myopathies [1].Objectives:In this study, we hypothesized that immune-related miRNAs may be associated with presence/absence of lung involvement in patients with ASSD and help predict disease course.Methods:A total of 15 ASSD patients were enrolled: 11 with ILD and 4 without ILD. Differentially expressed miRNAs were identified in plasma derived-exosome, using miRNA PCR array (MIHS-111ZG, Qiagen) including 84 miRNAs involved in activation and differentiation of T and B cells.Results:Among all miRNAs analyzed we found that miR-15b-5p, miR-23a-3p, miR-25-3p, miR-30a-5p and miR29c-3p were up-regulated in ASSD-ILD patients (p<0.05) as compared to patients without lung involvement (Figure 1). To evaluate the effectiveness of the five miRNAs for predicting ILD among ASSD patients, ROC curves were constructed. The AUCs of miR-15b-5p, miR-25-3p, miR-30a-5p and miR29c-3p were 0.83, 0.87, 0.86 and 0.89, respectively (p= 0.05 for miR-25-3p and p<0.05 for all other curves). The prediction of the biologic targets and pathways as well as cellular processes by DIANA-mirPath analysis showed that all miRNAs associated with ILD presence are involved in PI3K-Akt signaling pathway.Conclusion:Our study shows that, in ASSD patients with ILD, miR-15b-5p, miR-23a-3p, miR-25-3p, miR-30a-5p and miR29c-3p were up-regulated compared to patients without evidence of ILD. A clear involvement in immune and inflammatory diseases was documented for the miRNAs identified [2] and, for many of these, studies in the literature indicate a possible role in pulmonary fibrosis [3]. It is notable that these miRNAs were related to PI3K-Akt signaling pathway that regulate cell proliferation, differentiation and apoptosis [4]. It has also been demonstrated that in lung fibroblast the PI3K–Akt signals can be aberrantly activated [5]. The identification of markers could be important in the early identification of the disease and for its treatment.References:[1]Kalluri M, Oddis CV. Pulmonary manifestations of the idiopathic inflammatory myopathies. Clinics in chest medicine. 2010; 31:501–512.[2]Prabahar A, Natarajan J, ImmunemiR-a database of prioritized immune miRNA disease associations and its interactome. MicroRNA, 2017; 6: 71–78.[3]Sessa R, Hata A. Role of microRNAs in lung development and pulmonary diseases. Pulm Circ. 2013; 3:315-28.[4]Ersahin T, Tuncbag N, Cetin-Atalay R. The PI3K/AKT/mTOR interactive pathway. Mol Biosyst. 2015;11:1946-54.[5]Zhang XL, Xing RG, Chen L, Liu CR, Miao ZG. PI3K/Akt signaling is involved in the pathogenesis of bleomycin-induced pulmonary fibrosis via regulation of epithelial-mesenchymal transition. Mol Med Rep. 2016;14:5699-5706.Figure 1.Comparison of relative levels of five miRNAs among patients with and without lung involvement were expressed as log2 transformed values. *p<0.05; **p<0.01Disclosure of Interests:None declared
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Garaiman A, Steigmiller K, Gebhard C, Mihai C, Dobrota R, Matucci-Cerinic M, Henes J, De Vries-Bouwstra J, Smith V, Doria A, Allanore Y, Dagna L, Anic B, Montecucco C, Kowal-Bielecka O, Martin M, Tanaka Y, Hoffmann-Vold AM, Held U, Distler O, Becker MO. POS0877 THE EFFECT OF PLATELET INHIBITORS ON DIGITAL ULCERS IN SYSTEMIC SCLEROSIS - A DERIVATION AND VALIDATION EUSTAR STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Digital ulcers (DUs) affect half of the patients with systemic sclerosis (SSc) and can be complicated by gangrene and amputation. The direct involvement of platelets in the development of DUs has been suggested by in vitro studies, which encouraged physicians to consider platelet inhibitors as a therapeutic option in the management of DUs. However, until now, there is no clinical study to assess the efficacy of platelet inhibitors for DUs in SSc patients.Objectives:To demonstrate a possible relationship between treatment with platelet inhibitors and the occurrence of DUs at the next follow-up visit in patients with SSc.Methods:This study used prospectively collected data from the European Scleroderma Trials and Research group (EUSTAR) registry. Patients fulfilling the 2013 ACR/EULAR SSc classification criteria with complete longitudinal data on the presence of DUs and platelet inhibitors were included in the analysis. Multiple imputation using a random forest algorithm was implemented to handle missing values.The dataset was split into a derivation and validation cohort. To investigate the response for the binary dependent variable of DUs, a generalized linear mixed model (GLMM) was developed in the derivation cohort and validated using ROC analysis and Brier scores to address discrimination and calibration, respectively.Results:Of 3,463 patients (2,961 in the derivation cohort, 722 in the validation cohort), 453 had current DUs at the baseline and 245 were exposed to platelet inhibitors (table 1).Our GLMM revealed that the exposure to platelet inhibitors is associated with a reduced risk of DUs at the next follow up visit (OR = 0.33, 95% CI = [0.13 to 0.82]). Further factors associated with absence or presence of DUs at the next follow-up visit are shown in figure 1. This confirmed the previously identified risk factors for the presence of DUs, supporting the overall robustness and the validity of our model.The performance was evaluated by ROC curve analysis and showed an AUC = 97.97% (95% CI = [96.93% to 97.67%]) for the derivation cohort and AUC = 77.3% (95% CI = [74.01% to 81.39%]) for the validation cohort, respectively, showing an acceptable discrimination. The Brier score was 0.05 in the derivation cohort and 0.07 in the validation cohort, suggesting a good calibration of the model.Conclusion:Our model, with acceptable discrimination and good calibration, suggests a positive treatment effect of platelet inhibitors on DUs in clinical practice.Table 1.Baseline characteristics of patients before imputationCharacteristicsOverallDerivation setValidation setn3,4632,691772Age (median [IQR])56.00 [47.00, 66.00]56.00 [47.00, 65.00] 57.00 [48.00, 67.00]Disease duration (median [IQR]) 9.00 [4.00, 16.00] 9.00 [4.00, 16.00] 8.00 [4.00, 15.00]Disease subset = Limited cutaneous SSc (%) 1562 (65.2) 1164 (64.6) 398 (66.9)DUs (%): Current 453 (13.1) 378 (14.0) 75 (9.7)DUs (%): Never 1783 (51.5) 1326 (49.3) 457 (59.2)DUs (%): Previously 1227 (35.4) 987 (36.7) 240 (31.1)mRSS (median [IQR]) 5.00 [2.00, 11.00] 6.00 [2.00, 12.00] 4.00 [1.00, 11.00]Joint Contractures = Yes (%) 881 (26.8) 770 (29.4) 111 (16.5)LVEF (median [IQR])62.00 [60.00, 65.00]60.00 [60.00, 65.00] 65.00 [60.00, 67.00]Dyspnea NYHA III and IV (%)300 (9.5)214 (8.6)86 (12.7)Pulmonary hypertension = Yes (%) 244 (10.7) 200 (11.3) 44 (8.4)Lung fibrosis on HRCT = Yes (%) 685 (46.6) 600 (47.7) 85 (39.7)FVC % predicted (median [IQR])97.00 [82.00, 111.00]95.00 [81.00, 110.00]101.00 [85.00, 115.00]Serum creatinine mg/dl (median [IQR]) 0.70 [0.60, 0.90] 0.70 [0.60, 0.90] 0.70 [0.70, 0.90]Anti-Scl-70 positive = Yes (%) 1147 (33.1) 958 (35.6) 189 (24.5)CRP elevation = Yes (%) 639 (21.1) 490 (20.8) 149 (22.1)Platelet inhibitors therapy = Yes (%) 245 (7.1) 206 (7.7) 39 (5.1)Oral anti-coagulants therapy = Yes (%) 53 (1.5) 50 (1.9) 3 (0.4)Disclosure of Interests:None declared
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Zanatta E, Huscher D, Airò P, Balbir-Gurman A, Siegert E, Ortolan A, Matucci-Cerinic M, Cozzi F, Riemekasten G, Hoffmann-Vold AM, Distler O, Gabrielli A, Heitmann S, Hunzelmann N, Montecucco C, Morovic-Vergles J, Ribi C, Doria A, Allanore Y. POS0318 CLINICAL PHENOTYPE IN SCLERODERMA PATIENTS WITH ANTI-TOPOISOMERASE I POSITIVITY AND LIMITED CUTANEOUS FORM: DATA FROM THE EUSTAR DATABASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:There is renewed interest in the role of autoantibodies to predict outcomes in systemic sclerosis (SSc). Among the newly identified subsets, patients with limited cutaneous form (lcSSc) but anti-topoisomerase I antibodies (Scl70) positivity draw particular attention, and namely, assessing the risk of developing interstitial lung disease (ILD) —the main cause of death in SSc—to improve the management of Scl70-lcSSc patients.Objectives:We aimed to characterize patients with Scl70-lcSSc in the large multicenter European Scleroderma Trial and Research (EUSTAR) cohort.Methods:The EUSTAR database was locked in July 2019. We included all patients fulfilling 1980 ACR and/or 2013 ACR/EULAR criteria for SSc, with disease duration at database entry ≤3 yrs and known and stable skin form during the first 3 yrs. Patients with lcSSc were compared: Scl70-lcSSc (target group) vs. ACA-lcSSc and ANA-lcSSc (Step 1); and Scl70-lcSSc vs. Scl70-dcSSc (Step 2). In the ANA subgroup we included ANA+ patients with negative SSc-specific antibodies (Scl70, ACA, RNA polymerase III). In each step, we performed 5 generalized mixed models (GMM) for the risk of the new onset of ILD (defined by imaging), primary myocardial involvement (PMI), pulmonary hypertension (PH), “any severe” (ILD+PMI+PH+scleroderma renal crisis) and all-cause-mortality. An additional GMM assessed the risk of forced vital capacity (FVC) decline ≥10% vs. FVC value at ILD onset. Each GMM was adjusted for age, sex and confounders.Results:Overall, 1285 SSc patients were included: 1068 (83%) females, 860 (67%) lcSSc and 425 (33%) dcSSc. Among patients with lcSSc, 537 (62%) had ACA+, 194 (23%) Scl70+ and 129 (15%) ANA+; 425 patients had dcSSc and Scl70+. Median follow-up was similar in all 4 groups: 7.2 to 8.1 yrs.Step 1: At baseline, Scl70-lcSSc patients had significantly shorter time from Raynaud’s phenomenon (RP) to SSc onset, higher mRSS (5.8±4.8 vs. 4.3±4, p=0.001), and higher rate of articular and muscular involvement vs. ACA-lcSSc patients (Figure 1). No differences were found between Scl70-lcSSc and ANA-lcSSc comparing the aforementioned variables. ILD was more frequent in Scl70-lcSSc (46%) than in ACA-lcSSc (10%) and ANA-lcSSc (25%), as well as restrictive lung disease. GMM showed that Scl70-lcSSc carries a higher risk of ILD than both ACA-lcSSc (HR 4.55, 95%CI 3.23-6.67) and ANA-lcSSc (HR 2.17, 95%CI 1.39-3.45), with a rate of FVC decline ≥10% over time similar to the other limited forms. In Scl70-lcSSc patients the risk of “any severe” organ involvement was similar to ANA-lcSSc and higher than ACA-lcSSc (HR 1.89, 95%CI 1.40-2.50). In particular, Scl70-lcSSc shows a risk of PMI similar to ANA-lcSSc and lower than ACA-lcSSc; no differences regarding PH risk. The mortality risk in patients with Scl70-lcSSc was similar to the other limited forms’.Step 2: At baseline, time from RP to SSc onset was longer in patients with Scl70-lcSSc, with less frequent joint synovitis and tendon friction rubs vs. patients with Scl70-dcSSc. Conversely, the frequency of muscular, cardiac and pulmonary involvement was similar. The risk of ILD in Scl70-lcSSc patients was similar to Scl70-dcSSc, with a lower risk of FVC decline ≥10% over time. The risk of “any severe” involvement (HR 0.66, 95%CI 0.49-0.83), PMI and PH was lower and the mortality risk tended to be lower (HR 0.57, 95%CI 0.33-1.01, p=0.053) vs. Scl70-dcSSc.Conclusion:In our large multicenter EUSTAR cohort one quarter of lcSSc patients were Scl70+. We show a ranking for major organ involvement within lcSSc: Scl70 the most severe, ANA+ intermediate and ACA the milder form. Scl70-dcSSc patients present the most severe phenotype, and Scl70 positivity, more than the cutaneous subset, is strongly predictive of ILD, whereas other variables may influence progression. These results may provide new insight to improve the management of Scl70-lcSSc patients.Disclosure of Interests:Elisabetta Zanatta: None declared, Dörte Huscher: None declared, Paolo Airò: None declared, Alexandra Balbir-Gurman: None declared, Elise Siegert: None declared, Augusta Ortolan: None declared, Marco Matucci-Cerinic: None declared, Franco Cozzi: None declared, Gabriela Riemekasten: None declared, Anna-Maria Hoffmann-Vold: None declared, Oliver Distler Speakers bureau: has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: has/had consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: Kymera Therapeutics, Mitsubishi Tanabe, Armando Gabrielli: None declared, Stefan Heitmann: None declared, Nicolas Hunzelmann: None declared, Carlomaurizio Montecucco: None declared, Jadranka Morovic-Vergles: None declared, Camillo Ribi: None declared, Andrea Doria: None declared, Yannick Allanore: None declared
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De Stefano L, Bugatti S, D’Onofrio B, Favalli E, Manzo A, Caporali R, Montecucco C. POS0575 THE PATIENT GLOBAL ASSESSMENT (PGA) OF DISEASE ACTIVITY COLLECTS DIFFERENT INFORMATION IN EARLY COMPARED TO ESTABLISHED RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The patient global assessment (PGA) is the most widely used patient-reported measure in rheumatoid arthritis (RA), being a component of disease activity scores and definitions of remission. Studies have however shown that, at least in established RA, PGA is mostly associated with pain, functional limitation, psychological distress and comorbidities, rather than with objective measures of inflammation. As such, the inclusion of PGA as a driver of intensification of immunosuppressive therapy is been questioned. Determinants of PGA may however differ in the earliest stages of RA, when pain processing mechanisms and damage accrual have not occurred yet. Whether the association of PGA with disease activity in RA changes over time is at present undetermined.Objectives:To analyze the associations between PGA and disease activity measures in patients with RA across different phases of the disease.Methods:1.002 RA patients from two independent cohorts were included: 1) a prospective longitudinal cohort of early RA (<12 months of symptoms) (n=601) with an observation period of 24 months upon initiation of therapy with methotrexate; 2) a cross-sectional cohort of established RA (duration >5 years) (n=401) with inadequate response to methotrexate. Determinants of PGA were assessed by Pearson’s correlation coefficients and multivariable linear regression.Results:In early RA, median (IQR) symptom duration at inclusion was 15 (9-27) weeks, 71.5% of the patients were female, 49.3% were autoantibody-positive, and 30% had radiographic evidence of ≥1 erosion. The mean (SD) DAS28 was 4.94 (1.19), and the mean (SD) PGA 57.6 (26.6). The proportion of patients at least in low disease activity (DAS28 <3.2) after 6, 12 and 24 months of treatment was 49.9%, 57.4% and 67% respectively. The associations of PGA with pain and functional limitation were moderate to good (r >0.40) at all time points, and were independent of other co-variates (Table 1). Swollen joints (SJC28) were independently and directly associated with PGA at all time points until 12 months, whilst the association become indirect at 24 months (Table 1). In ACPA-positive patients, PGA at 6 and 12 months was weakly but still significantly associated with SJC28 even in low disease activity states (adj r 0.15 and 0.13, p<0.05). Patients with established RA had a mean [SD] DAS28 of 5.3 [1.2] and were ACPA-positive in 69.6% of the cases. Independent determinants of PGA were pain, HAQ and tender joints, whilst no associations with SJC28 and acute phase reactants were found neither in the overall cohort nor in ACPA-positive patients.Conclusion:In established RA, PGA appears mostly related to factors outside the core domains of disease activity. In contrast, in the early phases of the disease, PGA may more strictly collect information on inflammatory-related symptoms. Better understanding of the relationship between patient reported outcomes and disease activity in the various phases of RA may thus be needed before introducing definitive changes in the current definitions of disease activity.References:[1]Nikiphorou E et al. Arthritis Res Ther 2016;18:251[2]Ferreira RJO et al. Ann Rheum Dis 2019;78:e109.Table 1.Associations of PGA in early RA at different time points0 months6 months12 months24 monthsr (95% CI)pr (95% CI)pr (95% CI)pr (95% CI)pVAS pain0.74 (0.70-0.77)<0.0010.83 (0.80-0.86)<0.0010.84 (0.80-0.86)<0.0010.83 (0.79-0.87)<0.001HAQ0.47 (0.41-0.54)<0.0010.54 (0.46-0.62)<0.0010.57 (0.50-0.63)<0.0010.50 (0.41-0.59)<0.001SJC280.27 (0.19-0.35)<0.0010.27 (0.18-0.35)<0.0010.21 (0.12-0.30)<0.0010.23 (0.13-0.33)<0.001TJC280.34 (0.27-0.41)<0.0010.39 (0.31-0.47)<0.0010.39 (0.30-0.46)<0.0010.30 (0.20-0.40)<0.001CRP0.08 (0.00-0.17)0.050.09 (0.00-0.19)0.070.19 (0.10-0.28)<0.0010.03 (0.09-0.14)0.63β standpβ standpβ standpβ standpVAS pain0.66<0.0010.76<0.0010.74<0.0010.80<0.001HAQ0.20<0.0010.180.010.200.030.220.003SJC280.170.030.150.040.110.04----TJC28----------------CRP------------Acknowledgements:I have no acknowledgements to declare.Disclosure of Interests:Ludovico De Stefano: None declared, Serena Bugatti Speakers bureau: BMS, Lilly, Sanofi, Pfizer, Galapagos, Bernardo D’Onofrio: None declared, Ennio Favalli Speakers bureau: AbbVie, MSD, Novartis, Pfizer, UCB Pharma, Antonio Manzo: None declared, Roberto Caporali Speakers bureau: AbbVie, BMS, Celgene, HSD, Lilly, Pfizer, Roche, UCB Pharma, Carlomaurizio Montecucco Speakers bureau: BMS, Lilly, Sanofi, Pfizer, Galapagos, Roche, Novartis
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Favalli EG, Iannone F, Gremese E, Gorla R, Foti R, Conti F, Rossini M, Fusaro E, Cantatore FP, Montecucco C, Sebastiani M, Cauli A, Ferraccioli G, Lapadula G, Caporali R. POS0675 THE COMPARATIVE 3-YEAR RETENTION RATE OF TARGETED-SYNTHETIC AND BIOLOGIC DRUGS FOR RHEUMATOID ARTHRITIS: REAL-LIFE DATA FROM THE ITALIAN GISEA REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Long-term observational data on the real-life use of JAK inhibitors (JAKis) for rheumatoid arthritis (RA) and their comparison with biological drugs are still very limited. Large population-based registries have been increasingly used to investigate the performance of targeted drugs in a real-life setting.Objectives:The aim of this study is to evaluate and compare the 3-year retention rate of JAKis, TNF inhibitors (TNFis) and biologic drugs with other mechanisms of action (OMAs) in the large cohort of RA patients included in the Italian national GISEA registry.Methods:Data of all RA patients treated with targeted synthetic or biologic drugs were prospectively collected in the Italian multicentric GISEA registry. The analysis was limited to patients who started a first- or second-line targeted drug in the period after the first JAKi was marketed in Italy (1st December 2017). The 3-year retention rate was calculated by the Kaplan-Meier method and compared between different drug classes by a log-rank test. A descriptive analysis of reasons for discontinuation was performed.Results:The study population included 1027 RA patients (79.8% females, mean age [±SD] 56.9 [±13.5] years, mean disease duration 9.8 [±9] years, mean baseline SDAI 17.5 [±11.9], ACPA positive 67.4%, RF positive 62.7%) who received JAKis (baricitinib or tofacitinib, n=297), TNFis (n=365), or OMAs (n=365) as first or second targeted drug. Main baseline characteristics of study population were overall well balanced between treatment groups. Retention rate was numerically but not statistically higher (p=0.18) in patients treated with JAKis compared with TNFis or OMAs (80.6, 78.9 and 76.4% at 1 year and 73, 56.8 and 63.8% at 3 years, respectively) (Figure 1). Drug survival was significantly higher in patients receiving concomitant methotrexate (MTX) compared with monotherapy only in TNFis (66.8 vs 47.1%, p=0.04) but not in JAKis (76.1 vs 70.1%, p=0.54) and OMAs (66.1 vs 61.9%, p=0.41) group. Therapy was discontinued in a total of 211 patients because of ineffectiveness (n=107), adverse events (n=88), or compliance/other reasons (n=16). The most frequent reason for treatment withdrawal was ineffectiveness in both JAKis (n=30 out of 56) and TNFis (n=45 out of 74) groups, whereas OMAs were discontinued more frequently because of adverse events (n=41 out of 81).Conclusion:Our data confirmed in a real-life setting a favorable 3-year retention rate of all available targeted mechanisms of action for RA therapy. As expected, concomitant MTX significantly impacted persistence on therapy of TNFis only. Discontinuations of JAKis for adverse events were infrequent overall, confirming the safety profile observed in randomized clinical trials.Figure 1.Three-year retention rate by treatment groupDisclosure of Interests:None declared
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Bixio R, Biglia A, Virelli G, Giollo A, Montecucco C, Rossini M. AB0911-HPR ROLE OF MOBILE APPLICATIONS IN RHEUMATOLOGY CARE: A MULTICENTRIC SURVEY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Although mobile health applications (apps) are becoming increasingly popular across several medical specialties, no data are available in rheumatology. The aim of this study is to investigate whether apps are routinely used by rheumatologists.Objectives:In our study we aim assess real-life use of mobile applications in rheumatology clinical activity and to evaluate mobile apps role in rheumatology training, in particular for residents, and clinical activity.Methods:We invited a non-selected sample of rheumatologists (consultants, residents and medical students committed to begin rheumatology residency) to participate in an anonymous web-based survey. This survey investigated mobile application use in rheumatology care and issues and concerns about mobile device use in rheumatology.Results:Sixty participants completed the survey (40% consultants, 48.3% residents, 11.7% students). 52/60 (86.7%) declared to use mobile apps during their work. More than 50% used apps at least once a day. Apps were mostly used for calculating clinical disease activity scores for chronic inflammatory arthritides. Most rheumatology residents stated that these apps could be a useful tool in medical training. However, using a smartphone during a clinical examination was deemed to be inappropriate by 26/60 (43.3%).Conclusion:Mobile apps as clinical tools are widespread among rheumatologists.References:[1]Newzoo Global Mobile Market Report 2019 | Light Version [Internet]. Newzoo. [cited 2021 Jan 23]. Available from: https://newzoo.com/insights/trend-reports/newzoo-global-mobile-market-report-2019-light-version/.[2]eHealth WGO for. mHealth: new horizons for health through mobile technologies: second global survey on eHealth [Internet]. World Health Organization; 2011 [cited 2021 Jan 4]. Available from: https://apps.who.int/iris/handle/10665/44607.[3]Grainger R, Townsley H, White B, Langlotz T, Taylor WJ. Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality. JMIR MHealth UHealth. 2017;5:e7.[4]Salaffi F, Farah S, Di Carlo M. Smartphone APPlications in the clinical care and management of Rheumatic Diseases. Acta Bio Medica Atenei Parm. 2018;89:7–26.[5]Maassen O, Fritsch S, Gantner J, Deffge S, Kunze J, Marx G, et al. Future Mobile Device Usage, Requirements, and Expectations of Physicians in German University Hospitals: Web-Based Survey. J Med Internet Res [Internet]. 2020 [cited 2021 Jan 23];22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781804/.[6]Solomon DH, Rudin RS. Digital health technologies: opportunities and challenges in rheumatology. Nat Rev Rheumatol. Nature Publishing Group; 2020;16:525–35.[7]Adami G, Giollo A, Rossini M, Orsolini G, Benini C, Viapiana O, et al. Different fracture risk profile in patients treated with anti-osteoporotic drugs in real-life. Reumatismo. 2020;72:71–4.[8]Maurits M, Yuminaga H, Huizinga T, Knevel R. Mobile health applications in rheumatology: Could they improve our care and research? Int J Clin Rheumatol. Open Access Journals; 2019;14:44.Acknowledgements:We thank prof. Punzi for helping to spread the survey among Rete Reumatologica VenetaDisclosure of Interests:None declared
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Delvino P, Milanesi A, Brandolino F, Monti S, Montecucco C. POS0250 SIGNIFICANT DAMAGE OCCURS EARLY IN THE COURSE OF EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS AND IS MAINLY DUE TO DISEASE-RELATED SEQUELAE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Following the introduction of effective immunosuppressive treatments, ANCA-associated vasculitides (AAV) have become chronic diseases with a remitting-relapsing course. Therefore, preventing chronic damage accrual during follow-up is critical, as relapses, treatment-related side effects, and comorbidities may significantly affect the long-term outcomes of AAV patients. At present, no study specifically evaluated the burden of damage in patients with eosinophilic granulomatosis with polyangiitis (EGPA).Objectives:To describe short-term (6 months) and long-term (5 years) damage accrual in patients with newly diagnosed EGPA.Methods:Patients diagnosed with EGPA, according to ACR criteria and/or Chapel Hill definitions and regularly followed-up in our vasculitis center for ≥5 years were included. Damage accrual was assessed with the Vasculitis Damage Index (VDI). Short-term and long-term damage accrual was defined by VDI at 6 months and at 5 years, respectively, and categorized as related to vasculitis or its treatment.Results:VDI data at 6 months were available for 45 EGPA patients: 24 (53.3%) female, mean age at diagnosis 51.6±13.0 years. ANCA were positive in 17 patients (37.8%), with MPO being the only detected enzyme immunoassay (EIA)-specificity. At 6 months mean VDI was 2.8±1.3; 25/45 (55.6%) and 6/45 patients (13.3%) presented ≥3 and ≥5 items, respectively, whilst only 1 patient (2.2%) showed no items of damage. VDI data at 5 years were available for 32/45 EGPA patients (71.1%): 16 (50%) female, mean age at diagnosis 51.5±13.1 years. MPO-ANCA were positive in 13 patients (40.6%). At 5 years mean VDI was 3.5±1.3, with 26/32 (81.3%) and 7/32 patients (21.9%) presenting ≥3 and ≥5 items, respectively; notably, no patients presented a VDI=0 at 5 years.The most frequent disease-related VDI items at 6 months and at 5 years were asthma, chronic sinusitis, peripheral neuropathy, cardiomyopathy, pulmonary function tests abnormalities and nasal blockage (Figure 1). Osteoporotic fractures, diabetes and systemic hypertension were the most commonly reported treatment-related items at 6 months and at 5 years (Figure 1). Damage accrual progressively rose during the 5-year follow-up (P=0.023), mainly due to disease-related items rather than treatment-related items both at 6 months (disease related VDI 2.6±1.2, treatment-related VDI 0.3±0.6) and at 5 years (disease related VDI 2.9±1.2, treatment-related VDI 0.6±0,7). No significant difference in terms of damage accrual was observed between ANCA-positive and ANCA-negative patients (P >0.5).Conclusion:In our cohort of EGPA patients damage accrual occurs early, with more than half of the patients displaying ≥3 VDI items already at 6 months. Poor control of previous disease activity, particularly ENT and respiratory manifestations, contributes to progressive damage accrual more than treatment side effects.Figure 1.Disease-related and treatment-related VDI items at 6 months and at 5 years in patients with EGPA.Disclosure of Interests:None declared
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D’onofrio B, De Stefano L, Palermo BL, Xoxi B, Manzo A, Montecucco C, Bugatti S. POS1258 MISSING THE WINDOW OF OPPORTUNITY: EARLY ARTHRITIS CLINICS IN TIMES OF COVID-19. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The outcomes of patients with chronic inflammatory arthritis (IA), such as rheumatoid arthritis (RA), have dramatically improved over the past 20 years. Earlier identification of IA and prompter treatment institution have been key advancements, promoted by the constitution of Early Arthritis Clinics (EAC) and the development of more sensitive classification criteria for RA. The outbreak of new COronaVIrus Disease 2019 (COVID-19) has quickly become a global health emergency and has forced a rearrangement in the management of other non-COVID-19 diseases. The impact of the lock-down of the healthcare systems on chronic inflammatory diseases such as RA is expected to be significant but is at present unknown.Objectives:To assess the effects of the lock-down imposed by the COVID-19 pandemic on the referral and clinical presentation of patients with new-onset RA.Methods:Data were retrieved from the Pavia EAC inception cohort, established in 2005 for the early identification of patients with new-onset IA. Referral criteria to the EAC include: ≥3 swollen joints (SJ) and/or <3 SJ and positive squeeze test and/or <3 SJ and morning stiffness >30 min. Demographic and clinical characteristics of the patients are assessed at baseline and regularly over follow-up.At 31 Dec 2020, the Pavia EAC collects information on 2.508 patients. For this study, baseline characteristics of the patients referred in the semester following the COVID-19 lock-down (Jul-Dec 2020) were compared with: (i) patients referred in the semester immediately preceding the lock-down (Jul-Dec 2019); (ii) patients referred in the semester following the publication of the 2010 RA classification criteria (Jan-Jun 2011); (iii) patients referred in the semester preceding the publication of the 2010 criteria (Jul-Dec 2009).Results:In the semester following the lock-down imposed by the COVID-19 pandemic, there was a decrease in the referral of patients with new-onset suspected IA compared with previous periods (n=71 vs n=91 in the semester before the lock-down, n=96 in the first semester of 2011, n=101 in the second semester of 2009). Furthermore, fewer of the referred patients fulfilled RA criteria at presentation (36.6% vs 44.3%, 46.5% and 42.9% in the other semesters). Among patients with RA, more were autoantibody-positive (72% vs 50%, 49.1% and 52.2%). There was a trend for increased diagnostic delay in the overall cohort of RA after the COVID-19 lock-down (Figure 1A). The delay was particularly longer in autoantibody-positive patients, returning to the values seen before the introduction of the 2010 RA criteria (Figure 1B). In contrast, the few autoantibody-negative patients were referred earlier (Figure 1C). Disease activity at presentation was significantly higher in RA patients presenting after the lock-down compared with the progressive trend for reduction observed over the previous years, irrespective of the autoantibody status (Figure 1D-F). Such increase was determined by an inversion of the trend towards lower levels of objective parameters of inflammation, such as the swollen joint count (Figure 1G-I) and acute phase reactants, and a further increase in the secular trend towards worsening of patient-derived measures, such as the tender joint count and patient global assessment (Figure 1J-L).Figure 1.Effects of COVID-19 lock-down on new-onset RA at presentation.Conclusion:The COVID-19 pandemic is posing unprecedented challenges in the management of patients suffering from chronic diseases. RA has returned to be diagnosed outside the window of opportunity, with a significantly higher inflammatory burden at presentation. The many benefits of early diagnosis, which have dramatically changed the outcomes of autoantibody-positive RA, are at risk of vanishing in short times. Equally important, autoantibody-negative RA is at risk of further under-diagnosis and under-treatment.Disclosure of Interests:Bernardo D’Onofrio: None declared, Ludovico De Stefano: None declared, Bianca Lucia Palermo: None declared, Blerina Xoxi: None declared, Antonio Manzo: None declared, Carlomaurizio Montecucco Speakers bureau: BMS, Lilly, Sanofi, Pfizer, Galapagos, Roche, Novartis, Serena Bugatti Speakers bureau: BMS, Lilly, Sanofi, Pfizer, Galapagos
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Monti S, Delvino P, Klersy C, Coppa G, Milanesi A, Montecucco C. POS0830 FACTORS INFLUENCING PATIENT-REPORTED OUTCOMES IN ANCA-ASSOCIATED VASCULITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patient-reported outcomes (PROs) are currently poorly integrated in the clinical evaluation of disease activity in patients with ANCA-associated vasculitis (AAV).Objectives:To assess the distribution of the Patient Global Assessment (PtGA) in patients with AAV in stable remission, and to identify correlates of PtGA; to assess the discordance between PtGA score and PhGA.Methods:Patients with a diagnosis of AAV [eosinophilic granulomatosis with polyangiitis, granulomatosis with polyangiitis, microscopic polyangiitis] in stable, complete remission (defined by a BVAS=0) and with a Physician Global Assessment (PhGA)=0 were included. A questionnaire including several aspects of disease captured by PROs was collected. PtGA on a 0-100 mm visual analogue scale (VAS) was assessed, with higher scores representing higher/worse levels of disease activity. Similarly, VAS for pain, chronic damage according to the patient’s opinion, general health (GH), fatigue, and sleep quality were collected. The worst symptom in the patient’s opinion affecting the overall assessment of disease activity was recorded. The Cragg Hurdle model was used to assess the predictors of PtGA.Results:65 patients were included, female 57%, mean age 61±12 years. Mean disease duration at enrollment was 8±6 years. Mean vasculitis damage index (VDI) was 4.4 ±2.3, with 45% of patients having a VDI ≥ 5. Despite having been classified as being in remission, PtGA was elevated in 37% of patients. We explored several correlates of PtGA. Higher degree of damage accrual (VDI) did not influence the patient’s evaluation of current disease activity. Similarly, we did not identify a correlation between older age, educational level, number of organ-systems involved, number of comorbidities, the number of previous major or minor relapses, higher disease duration, nor the type of AAV diagnosis (figure 1, panel A). Only sex significantly correlated with PtGA scores: 19 (51%) of female patients reported an elevated PtGA compared to only 5 (18%) of male (p=0.009). PtGA resulted to be significantly correlated with other (mostly modifiable) PROs including VAS pain, perception of the level of chronic damage accrual, GH, and fatigue (figure 1, panel B). The agreement between patients’ and physicians’ assessments of disease activity was 63%. Patients reported pain, followed by chronic respiratory symptoms to be the worst-experienced ongoing manifestations affecting their evaluation of disease activity.Conclusion:A significant proportion of patients with AAV considered to be in remission by the physician still declares to have persistent aspects of uncontrolled disease. PtGA is significantly influenced by persistent pain and fatigue, which warrant better assessment in the future.Disclosure of Interests:None declared
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Marasco E, Mussa M, Motta F, Bobbio-Pallavicini F, Maserati R, Montecucco C, Bogliolo L. Denosumab for the treatment of HIV-associated osteoporosis with fractures in a premenopausal woman. Reumatismo 2021; 73:54-58. [PMID: 33874648 DOI: 10.4081/reumatismo.2021.1358] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/29/2020] [Indexed: 11/23/2022] Open
Abstract
The prevalence of osteoporosis is about three times greater in people living with HIV than in the general population. Bisphosphonates are the only class of antiresorptive drugs which have proved to be safe and effective in HIV patients. However, bisphosphonates are not recommended in women of childbearing age due to an increased rate of associated neonatal complications. To the best of our knowledge no reports on the use of denosumab in HIV-infected individuals have been published so far. We describe a 38 year-old woman with HIV, osteoporosis and vertebral fractures treated with denosumab, a monoclonal antibody targeting RANKL. After four years of treatment, bone mineral density improved, no new fractures occurred, and neither HIV reactivation nor opportunistic infections were observed. We show that denosumab could be a safe and effective approach for osteoporosis in patients with HIV and could be considered in women of childbearing age.
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Affiliation(s)
- E Marasco
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - M Mussa
- Infectious Disease Department, Policlinico San Matteo IRCCS Foundation, Pavia.
| | - F Motta
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - F Bobbio-Pallavicini
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - R Maserati
- Infectious Disease Department, Policlinico San Matteo IRCCS Foundation, Pavia.
| | - C Montecucco
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
| | - L Bogliolo
- Unit of Rheumatology, Policlinico San Matteo IRCCS Foundation, University of Pavia.
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Biglia A, Monti S, Morandi V, Delvino P, Bellis E, Rossi S, Cavagna L, Mugellini A, Canino C, Bogliolo L, Montecucco C. Is it really infective endocarditis? Distinguishing systemic vasculitis from its mimics. Scand J Rheumatol 2021; 51:76-77. [PMID: 33682580 DOI: 10.1080/03009742.2021.1881157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A Biglia
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - S Monti
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy.,PhD School of Experimental Medicine, University of Pavia, Pavia, Italy
| | - V Morandi
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - P Delvino
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy.,PhD School of Experimental Medicine, University of Pavia, Pavia, Italy
| | - E Bellis
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - S Rossi
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - L Cavagna
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - A Mugellini
- Department of Internal Medicine, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - C Canino
- Department of Traslational Oncology, Scientific Institute of Pavia Maugeri ICS, Pavia, Italy
| | - L Bogliolo
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
| | - C Montecucco
- Department of Rheumatology, IRCCS Polyclinic San Matteo Foundation General Hospital, University of Pavia, Pavia, Italy
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Caffetti C, Bogliolo L, Giuffrè G, Sozzi A, Degli Esposti L, Bellis E, Montecucco C, Reitano F, Triarico A, Silva S, Bejor M, Muzzi A, Mirabile P, Ramaioli N, Brait M. Multidisciplinary model for hospital-territory integrated management of patient with bone fragility: primary and secondary prevention of fractures according to severity and complexity. Reumatismo 2020; 72:75-85. [PMID: 32700873 DOI: 10.4081/reumatismo.2020.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/27/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to promote the construction of a real network and a shared diagnostic and therapeutic management model between hospitals and out-of-hospital healthcare services to capture as many patients with bone fragility as possible. Starting from the analysis of the clinical competences present in the province of Pavia, the bone specialists (BSs) organized some educational events involving both general practitioners (GPs) and hospital specialists. The Fracture Liaison Service (FLS) model, the revision of Note 79, the national plan for chronicity and the health reform of the Lombardy Regional Authority supported the structure of our model, in which the roles of clinicians are well defined and based on the complexity and severity of patients. In our method the GP has a central role as clinical manager, facilitating patient management and communication between the specialists and the BS. In January 2019, the Therapeutic Care Diagnostic Path (PDTA) shared between 2 bone specialists (BSs), 9 GPs, as reference treaters, and a multidisciplinary group of 25 specialists of the Province of Pavia was defined. The strategic directions of the two largest public hospitals in Pavia have supported the PDTA, which was validated by the quality departments of the hospitals themselves. Finally, sixty GPs belonging to the network have joined the PDTA. This model is the first example of integrated management between hospitals and out-of-hospital healthcare services for the primary and secondary prevention of fragility fractures (FF), where the GPs play a pivotal role as managers and supervisors to ensure proper care to chronic patients according to their levels of severity.
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Affiliation(s)
- C Caffetti
- U.O.C. Riabilitazione Specialistica di Voghera, ASST Pavia.
| | - L Bogliolo
- U.O.C. Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - G Giuffrè
- Medico di Medicina Generale, ATS Pavia.
| | - A Sozzi
- Fondazione Don Carlo Gnocchi, ONLUS Centro Santa Maria alle Fonti, Salice Terme, Pavia.
| | - L Degli Esposti
- CliCon S.r.l. - Health, Economics and Outcomes Research, Pavia.
| | - E Bellis
- U.O.C. Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - C Montecucco
- U.O.C. Reumatologia, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - F Reitano
- Direzione Sanitaria Aziendale, ASST Pavia.
| | - A Triarico
- Direzione Sanitaria, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - S Silva
- Direzione Sanitaria, ATS Pavia.
| | - M Bejor
- U.O.C. Riabilitazione Specialistica di Voghera, ASST Pavia.
| | - A Muzzi
- Software developer, freelance.
| | - P Mirabile
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - N Ramaioli
- UOS Accreditamento e Qualità, ASST Pavia.
| | - M Brait
- Direzione Generale, ASST Pavia.
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Burmester GR, Alvaro-Gracia JM, Betteridge N, Calvo J, Combe B, Durez P, Ferreira RJO, Fautrel B, Iagnocco A, Montecucco C, Ǿstergaard M, Ramiro S, Rubbert-Roth A, Stamm T, Szekanecz Z, Taylor PC, Van de Laar M. THU0579 “EVOLVING THE MANAGEMENT OF RA” PROGRAMME: EDUCATIONAL TOOLS TO SUPPORT DAILY PRACTICE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The eRA (evolving the management of RA) programme was initiated in Europe to provide practical educational tools that address unmet needs in the management of rheumatoid arthritis (RA). Several eRA tools – covering early access to care, management of comorbidities, treat-to-target strategies, and patient empowerment – are available to the rheumatology community. Through ongoing activities, the eRA Steering Committee (SC) identified a need for tools on non-pharmacological management of RA.Objectives:To improve accessibility to eRA tools for rheumatology professionals; to review the evidence base of non-pharmacological interventions to create new eRA resources that may support management decisions.Methods:A web platform providing information on eRA programme and tools was developed in 2019. The platform collects survey-based metrics to quantify perception of eRA and use of eRA tools in clinical practice. Platform and tools are translated to further support access and use across Europe.To address unmet needs in non-pharmacological patient management, the eRA SC reviewed the core literature on agreed priority interventions, including physical activity, diet, patient education and self-management, psychosocial interventions, occupational therapy and orthotics, hand exercises, and hydrotherapy/balneotherapy. Available evidence for each intervention was assessed and graded according to the Oxford Centre for Evidence-based Medicine Levels of Evidence.Results:The eRA web platform is now live in 3 countries (www.evolvingthemanagementofRA.com), hosting translated copies of the eRA tools, with additional countries launching throughout 2020.From a review of core literature on non-pharmacological interventions, the eRA SC determined that strong evidence exists to support use of physical activity, patient education and self-management, psychosocial interventions, and occupational therapy and orthotics. Evidence was lacking or conflicting for diet and nutrition, hand exercises, and balneotherapy/hydrotherapy. A set of educational slides was produced by the eRA SC to summarise the evidence (Fig. 1) and provide top-line guidance on use of interventions in practice that should engage relevant members of the multi-disciplinary team. These slides are available through eRA dissemination activities.Conclusion:The eRA programme content is now freely available to health care professionals in several countries on a web platform, supported by translations of the eRA tools. An additional slide set on non-pharmacological management serves to further increase the practical guidance of this programme’s educational offering.Acknowledgments:The eRA programme is funded by Sanofi Genzyme. Programme direction and content creation are driven by an independent Steering CommitteeDisclosure of Interests:Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Jose-Maria Alvaro-Gracia Grant/research support from: Abbvie, Elli-Lilly, MSD, Novartis, Pfizer, Consultant of: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Paid instructor for: Elli-Lilly, Pfizer, Roche, Speakers bureau: Abbvie, BMS, Janssen-Cilag, Elli-Lilly, Gedeon Richter, MSD, Novartis, Pfizer, Sanofi, Tigenix, Roche, UCB, Neil Betteridge Consultant of: Amgen, Eli Lilly and Company, Grunenthal, GSK, Sanofi Genzyme, Jaime Calvo Grant/research support from: Lilly, UCB, Consultant of: Abbvie, Jansen, Celgene, Bernard Combe Grant/research support from: Novartis, Pfizer, Roche-Chugai, Consultant of: AbbVie; Gilead Sciences, Inc.; Janssen; Eli Lilly and Company; Pfizer; Roche-Chugai; Sanofi, Speakers bureau: Bristol-Myers Squibb; Gilead Sciences, Inc.; Eli Lilly and Company; Merck Sharp & Dohme; Pfizer; Roche-Chugai; UCB, Patrick Durez Speakers bureau: AbbVie, Bristol-Myers Squibb, Celltrion, Eli Lilly, Pfizer, Sanofi, Ricardo J. O. Ferreira Grant/research support from: Abbvie, Consultant of: Sanofi Genzyme, Amgen, MSD, Paid instructor for: UCB, Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi, Carlomaurizio Montecucco: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Andrea Rubbert-Roth Consultant of: Abbvie, BMS, Chugai, Pfizer, Roche, Janssen, Lilly, Sanofi, Amgen, Novartis, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Zoltán Szekanecz Grant/research support from: Pfizer, UCB, Consultant of: Sanofi, MSD, Abbvie, Pfizer, Roche, Novertis, Lilly, Gedeon Richter, Amgen, Peter C. Taylor Grant/research support from: Celgene, Eli Lilly and Company, Galapagos, and Gilead, Consultant of: AbbVie, Biogen, Eli Lilly and Company, Fresenius, Galapagos, Gilead, GlaxoSmithKline, Janssen, Nordic Pharma, Pfizer Roche, and UCB, Mart van de Laar Consultant of: Sanofi Genzyme, Speakers bureau: Sanofi Genzyme
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Bellis E, Monti S, Balduzzi S, Delvino P, Biglia A, Montecucco C. AB0462 BEHCET’S DISEASE: CLINICAL FEATURES AND OFF-LABEL BIOLOGIC TREATMENT STRATEGIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The treatment of Behçet’s disease (BD) is still mainly based on the evidence derived from case reports, case series, retrospective analyses, and few clinical trials suggesting the safety and potential efficacy of off-label use of biologic agents in refractory cases.1Objectives:To describe clinical manifestations and their management, with particular focus on treatment indications, outcomes and safety of biologic therapy, in a cohort of patients with BD.Methods:Patients with a diagnosis of BD who visited our outpatient clinic until December 2019 were included in the study. Clinical data were recorded since diagnosis until the latest follow-up visit, analyzing clinical features, flares and therapeutic strategies adopted.Results:A total of 95 patients were included in the study with a medium follow-up of 108.54 ± 169.59 months. 20 of them (21. 05%) were treated with biologic agents. Patients treated with biologic therapy compared to those on conventional non-biologic therapies had a higher proportion of musculoskeletal (80% vs 46.67%, p = 0.008), neurological (30% vs 10.67%, p = 0.031), intestinal involvement (40% vs 12%, p = 0.004), and they were treated with a higher dose of glucocorticoids at diagnosis (16.84 mg ±14.01 vs 8.89 mg ± 11.76, p = 0.012). The most frequent indications for biologic step-up therapy were musculoskeletal involvement (40%), eye involvement (25%), neurological involvement (15%) and intestinal involvement (10%). Most patients initiated a biologic treatment within the first year of follow-up. TNF-inhibitor (TNFi) were more frequently prescribed (95%) and one patient was treated with 8 therapeutic cycles of Rituximab (500 mg/weekly for 4 infusions to be repeated after at least 6 months) because of recurrent pancytopenia. All patients experienced non-biologic therapy before starting a TNFi. The preferred first-line TNFi was infliximab (50%), followed by adalimumab (40%) and etanercept (5%). As second line treatment were also prescribed certolizumab (10%) and golimumab (5%). 10 patients switched to a second line treatment because of inefficacy of the first biologic agent, mainly because of refractory arthritis, intestinal and mucocutaneous involvement. One patient switched from infliximab to certolizumab during pregnancy with subsequent worsening of arthritis.85% of patients treated with biologic agents reached a clinical remission by the time of the latest follow up visit without any safety or tolerability issues.Conclusion:A relevant proportion of patients in our BD cohort were treated with biologic therapy, because of severe or refractory manifestations. The most frequent indications were musculoskeletal, neurological or intestinal involvement. Biologic agents were a generally effective and safe therapeutic approach.References:[1]F. Alibaz-Oner, M. H. Sawalha, H. Direskeneli. Management of Behçet disease, Curr. Opin. Rheumatol, 2018Table 1.General characteristics and disease involvement at diagnosisBiologic therapyNo biologic therapyp value20 (21.05%)75 (78.95%)General characteristicsMediaSDMediaSDAge at disease onset(years ± SD)34.5± 10.4938.64± 13.18p = 0.1976Diagnostic delay(months ± SD)45.28± 67.4828.09± 48.42p = 0.1996Glucocorticoids at diagnosis (mg prednisone ± SD)16.84± 14.018.89± 11.76p = 0.0115Glucocorticoids at latest follow up visit (mg prednisone ± SD)6.38± 7.763.83± 4.81p = 0.0707N%N%F / M12 / 860 / 4054 / 4172 / 28p = 0.3030Disease involvement at diagnosisOral ulcers2010075100Genital ulcers11553749,33p = 0.6540Cutaneous lesions15755066,67p = 0.4787Eye involvement6302736p = 0.6184Musculoskeletal involvement16803546,67p = 0.0082Neurological involvement630810,67p = 0.0311Intestinal involvement840912p = 0.0039Thrombosis2101824p = 0.1747Disclosure of Interests:None declared
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Delvino P, Monti S, Bartoletti A, Bellis E, Brandolino F, Milanesi A, Montecucco C. SAT0256 THE ROLE OF FAST-TRACK ULTRASOUND IN PREVENTING EARLY COMPLICATIONS AND RELAPSES IN GIANT CELL ARTERITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Giant Cell Arteritis (GCA) is the most common form of primary systemic vasculitis, mainly affecting adults over 50 years old. Permanent visual loss (PVL) is one of the most feared complications, occurring in about 20% of cases, typically prior to initiation of high-dose glucocorticoid (GC) therapy. Color-duplex sonography (CDS) of temporal arteries (TAs) and large vessels (LVs) is recognized as a first-line diagnostic tool for patients with suspected GCA. A fast track approach (FTA), incorporating CDS has been associated to a significant reduction of PVL in two retrospective studies1,2.Objectives:To assess the impact of FTA on PVL and risk of relapses during follow-up compared to conventional care prior to the introduction of the FTA in our rheumatology clinic.Methods:Patients with new-onset GCA evaluated in our department from January 1998 to September 2019 were included in the study. The FTA approach for GCA was implemented since October 2016. The diagnosis of GCA was based on positive TAs and/or LVs CDS and/or a positive TA biopsy and clinical signs and symptoms of GCA. All patients were clinically examined by the same rheumatologist who performed the CDS. PVL was defined as total visual impairment in one or both eyes. Data on baseline clinical features and later outcomes were collected.Results:153 patients were included: 115 females (75.2%), mean age at diagnosis 71.6±8.2 years. Of these, 112 patients (73%) were evaluated conventionally and 41 (27%) with FTA. Patients in the FTA group were older (P=0.0002), presented more frequently with polymyalgia rheumatica symptoms, weight loss, jaw or tongue claudication and scalp tenderness (P<0.05 for all comparisons). The median duration of follow-up in the FTA group was shorter compared with the conventional group (1.5 vs 5.8 years). PVL occurred in 22 (19.6%) patients in the conventional group compared to 5 patient (12.2%) in the FTA, leading to a reduction of 37.9% in the relative risk of PVL with the FTA approach. Cumulative incidence of relapses and time to first relapse did not change after FTA introduction (P>0.05) (Fig. 1).Conclusion:The application of a FTA in GCA resulted in a significant reduction of PVL. However, the relapse rate did not seem to be influenced by the FTA, highlighting the need to implement further management strategies, besides earlier diagnosis and prompt initiation of GC, that would impact the course of the disease during long-term follow-upReferences:[1]Patil P, Williams M, Maw WW et al. Fast track pathway reduces sight loss in giant cell arteritis: results of a longitudinal observational cohort study. Clin Exp Rheumatol 2015;33(Suppl 89):S-103-6.[2]Diamantopoulos AP, Haugeberg G, Lindland A, Myklebust G. The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis? Rheumatology 2016;55:66_70.Fig. 1.Time to first relapse in patients with GCA and evaluated with a FTA compared to conventionally approached patients.Disclosure of Interests:None declared
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Delvino P, Sardanelli F, Monti S, Cohen P, Puéchal X, Montecucco C, Mouthon L, Guillevin L, Terrier B. AB0467 REMISSION AND LOW DISEASE ACTIVITY STATE IN PATIENTS WITH GRANULOMATOSIS WITH POLYANGIITIS AND MICROSCOPIC POLYANGIITIS: PREVALENCE AND IMPACT ON DAMAGE ACCRUAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) require glucocorticoids (GCs) and immunosuppressants (IS) to induce and maintain remission. At the era of highly active drugs and treat-to-target strategies, defining the goal to achieve in terms of remission could be beneficial for the long-term management.Objectives:To assess the impact of prolonged remission or low disease activity state (LDAS) in GPA and MPA patients and its relationship with damage accrual.Methods:Patients diagnosed with GPA and MPA, according to ACR criteria and/or Chapel Hill definitions, seen in two vasculitis centers and followed-up for ≥5 years were included. Disease activity was assessed by BVAS, and damage accrual by the VDI. Three levels of remission were defined: complete remission (CR): BVAS=0 and negative ANCA in GCs-free and IS-free patients; clinical remission off therapy: no disease activity and positive ANCA in GCs-free and IS-free patients; clinical remission on therapy: no disease activity in patients with low dose GCs (≤5 mg/d) and/or IS. LDAS was defined as 0<BVAS≤3 without major organ activity, no new disease activity, low-dose GCs (≤7.5 mg/day) and well-tolerated IS. We defined remission or LDAS as prolonged when lasting ≥2 consecutive years. The effect of prolonged remission and LDAS on damage accrual was evaluated.Table.Prevalence of vasculitic affection of respective arteries in patients with giant cell arteritis and polymyalgia rheumatica and patients with giant cell arteritis only.Affected arteryGroupPMR-GCA-group (n=27)GCA-group (n=18)UnilateralBilateralNoneUnilateralBilateralnoneAxillary artery9 (33%)12 (45%)6 (22%)5 (28%)7 (39%)6 (33%)Common superficial temporal artery3 (11%)21 (78%)3 (11%)5 (28%)13 (72%)0 (0%)Frontal branch6 (22%)17 (63%)4 (15%)3 (17%)11 (61%)4 (22%)Parietal branch5 (18%)21 (78%)1 (4%)3 (17%)13 (72%)2 (11%)Facial artery7 (26%)17 (63%)3 (11%)4 (22%)11 (61%)3 (17%)PMR-GCA-group: patients with diagnosis of giant cell arteritis and consecutive polymyalgia rheumaticaGCA-group: patients with diagnosis of giant cell arteritis onlyResults:167 patients were included: 128 (76.6%) GPA, mean age 51.0±16.7 years. At 5-years, mean VDI was 2.7±2.0, mainly because of AAV-related items (2.0±1.7) rather than treatment-related items (0.7±1.0). During the 5-year follow-up, 10 (6.0%) patients achieved prolonged CR, 6 (3.6%) prolonged clinical remission off therapy, 89 (53.3%) prolonged clinical remission on therapy, 42 (25.1%) prolonged LDAS and 20 (12.0%) never achieved LDAS. Damage accrual at 5-years in patients with prolonged CR, clinical remission off therapy, clinical remission on therapy, LDAS or those never achieved LDAS was 1.6±1.1, 1.8±1.7, 2.3±1.9, 3.8±2.0 and 3.3±2.0, respectively (P<0.0001). Damage was comparable between patients in prolonged remission off therapy and those in remission on therapy (P=0.3). In contrast, patients in prolonged LDAS or those never in LDAS had significantly more damage accrual (P<0.0001 and P=0.01, respectively) than those in prolonged remission off therapy. Eighty-one patients (49%) reached a VDI ≥3 at 5-years. The inability to achieve prolonged remission was associated with a VDI ≥3 at 5-years (OR 5.07, 95% CI 2.53-9.84, P<0.0001), and considering only prolonged CR or clinical remission off therapy did not had any benefit on damage accrual. In contrast, achieving prolonged LDAS had no benefit compared to spending no time in LDAS (P>0.99). Compared to patients achieving prolonged remission, those not able to achieve prolonged remission were younger (46±16.0 vs. 53.5±16.6, P=0.001), had more frequent GPA (P=0.0003), had more PR3-ANCA (P=0.006), had more ENT and lung involvement (P<0.0001 and P=0.036, respectively).Conclusion:Sixty percent of GPA and MPA patients achieved prolonged remission, which was associated with a better outcome in terms of damage accrual. In contrast, prolonged LDAS was associated with increased damage and was not a sufficient target to achieve in GPA and MPA.Disclosure of Interests: :None declared
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Zanframundo G, Sambataro G, Codullo V, Biglia A, Bozzalla Cassione E, Bravi E, Iannone F, Fornaro M, Triantafyllias K, Pesci A, Tomietto P, Molberg Ø, Scarpato S, Voll R, Matucci-Cerinic M, González-Gay MA, Montecucco C, Cavagna L. SAT0348 CLINICAL SPECTRUM TIME COURSE OF ANTISYNTHETASE SYNDROME PATIENTS POSITIVE FOR ANTICENTROMERE ANTIBODIES. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:ASSD is characterized by antisynthetase antibodies (ARS) and the triad arthritis/myositis/Interstitial Lung Disease (ILD). ASSD and systemic sclerosis (SSc) may share features, like Raynaud’s phenomenon (RP), capillaroscopic alterations, and also some SSc specific autoantibodies.Objectives:To evaluate the characteristics of ASSD + for anticentromere antibodies (ACA).Methods:Retrospective analysis of clinical and laboratory characteristics of ACA + ASSD. Patients were identified in an established international cohort, randomly matched 1:1 for sex, age, disease duration and ARS positivity with a group of ACA - ASSD.Results:18 ACA + ASSD (15 females, 83%, 15 anti-Jo1, 2 anti-PL7, 1 anti-PL12 ARS) patients were identified. In comparison to ACA - group, no differences were observed in disease clinical presentation and evolution. Though, 9 ACA + patients (50%) satisfied the ACR/EULAR 2013 classification criteria for SSc and only 1 in ACA - group (p=0.007) (Table 1).An incomplete ASSD (lack of at least one triad finding) was observed in 15 patients in both ACA + and – group (p=1). Among these patients, 13 ACA + and 11 ACA – developed de-novo triad finding during disease course (p=0.651). In ACA + group, a de-novo arthritis was observed in 4 patients (vs 1, p=0.565), a de-novo myositis in 8 (vs 5, p=1), and a de-novo ILD in 7 (vs 10, p=1). The prevalence of complete forms was similar between ACA + and – group at both disease onset (3 vs 3, 17%, p=1) and last follow-up, (10 vs 11, 56% vs 61%, p=1). Of note, only 1 patient (6%) for each group died (p=1).Conclusion:The clinical spectrum time course of ACA+ and - ASSD is similar, even when ACA + patients could be classified as SSc. By considering the high prevalence of arthritis and myositis we observed, we suggest that ACA+ patients with arthritis and myositis, should be tested for ARS antibodies even when an ASSD is not clearly suspected.References:[1]Mirrakhimov AE. Curr Med Chem 2015;22:1963–75[2]Cavagna L. J Clin Med 2019;8:E2013[3]Sebastiani M. J Rheum 2019:46:279-84[4]van den Hoogen F. Ann Rheum Dis 2013;72:1747-55Table 1.Patients characteristics. IQR, interquartile range; ILD, interstitial Lung Disease; SSc, systemic sclerosisACA+ (18)ACA - (18)pAge (years) at disease onset (median, IQR)47 (37-63)47 (39-63)0.834Disease duration (months) (median, IQR)81 (62-169)77 (58-165)0.486anti Ro52antibody (%)12(67)11 (61)1Arthritis onset10 (56)13 (72)0.489Arthritis last follow-up (%)14 (78)14 (78%)1Myositis onset (%)7 (39)11 (61)0.318Myositis last follow-up (%)15 (83)16 (89)1ILD onset (%)9 (50)6 (33)0.5ILD last follow-up (%)16 (89)16 (89)1Complete form onset (%)3 (17)3 (17)1Complete form last follow-up (%)10 (56)11 (61)1Raynaud phenomenon (%)13 (72)9 (50)0.305Mechanic’s hands (%)6 (33)7 (38)1Teleangectasias (%)2 (11)0 (0)0.486Cutaneous sclerosis (%)510.177Acral ulcers (%)1 (6)0 (0)1Scleroderma pattern at NVC8 (44)7 (39)1Pulmonary arterial hypertension (%)3 (17)2 (11)12013 ACR/EULAR SSc classification criteria9 (50)1 (6)0.007Disclosure of Interests:Giovanni Zanframundo: None declared, Gianluca Sambataro: None declared, Veronica Codullo: None declared, Alessandro Biglia: None declared, Emanuele Bozzalla Cassione: None declared, Elena Bravi: None declared, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Marco Fornaro: None declared, Konstantinos Triantafyllias: None declared, Alberto Pesci: None declared, Paola Tomietto: None declared, Øyvind Molberg: None declared, Salvatore Scarpato: None declared, Reinhard Voll: None declared, Marco Matucci-Cerinic Grant/research support from: Actelion, MSD, Bristol-Myers Squibb, Speakers bureau: Acetelion, Lilly, Boehringer Ingelheim, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Carlomaurizio Montecucco: None declared, Lorenzo Cavagna: None declared
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Bozzalla Cassione E, Biglia A, Zanframundo G, Grignaschi S, De Stefano L, Delvino P, Marasco E, Montecucco C, Cavagna L. AB0555 ANTI-RO POSITIVITY EFFECT ON CLINICAL CHARACTERISTICS AND MORTALITY IN A SINGLE-CENTER COHORT OF ANTISYNTHETASE SYNDROME PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Antisynthetase syndrome (ASSD) is an heterogeneous disease characterized by the occurrence of anti-synthetase antibodies (ARS) and the classic triad of arthritis, myositis and Interstitial Lung Disease (ILD). Pulmonary involvment bears an increased risk of life threatening events, being the main cause of mortality in these patients. No significant differences in mortality have been noticed among the different ARS specificities. However the role of extractable nuclear antigen antibodies on mortality in these patients is still matter of debate.Objectives:To asses the effect of anti-RO antibodies on clinical characteristics and mortality in a large italian single-center cohort of ASSD patients.Methods:Cohort study of outcome, clinical and laboratory characteristics, at baseline and at last follow-up, of 55 ASSD patients progressively enrolled and followed-up at our out-patient clinic. Survival was estimated with Kaplan-Meier function and comparison between frequencies of clinical characteristics was studied with Chi-square test.Results:We identified 30 anti-Ro+ (M:F=1:4) and 25 anti-Ro- (M:F=1.5:1) ASSD patients. No difference in the age of onset was observed (p value=0.83). Classic triad prevalence and evolution was similar between the two groups with only significant difference of ILD prevalence at last follow up, higher in anti-Ro+ patients group (p value=0.01). Overall mortality was of 13 subjects (23%) during the follow-up period (median 53 months, IQR 16-114). Despite the significantly higher pulmonary involvment in the anti-Ro+ group no difference between mortality in anti-Ro positive and negative groups was observed. Adjusting mortality to include disease-related events only did not provide any additional difference (p value=0.5) (Table 1). Survival curves of the two groups were not different at any time point (Log-rank test, p value 0.98) (Figure 1).Table 1.Clinical and Demographic Characteristics of the cohortASSDRo+Ro-P valuePZ (M:F)30 (6:24)25 (14:10)/Age (years) at disease onset (median, IQR)56 (43-69)54 (46-68)0.83Disease duration (months) (median, IQR)55 (23-112)52 (13-130)0.681Arhtritis at onset (%)22 (73)17 (68)0.664Arhtritis at last follow-up (%)26 (86)18 (72)0.175Myositis at onset (%)12(40)15 (60)1Myositis at last follow-up (%)19 (63)21 (84)0.086ILD at onset (%)20 (66)12 (48)0.162ILD at last follow-up (%)30(100)20 (80)0.01Complete form at onset (%)8 (26)4 (16)0.34Complete form at last follow-up (%)17 (56)13 (52)0.729Raynaud phenomenon (%)7 (23)8 (32)0.472Mechanic’s hands (%)12 (40)12 (48)0.551Death (%)7 (25)6 (24)0.953Disease related death (%)3 (42)4 (66)0.506Figure 1.Kaplan-meier curve of anti-Ro+ and anti-Ro – ASSD patients.Conclusion:The clinical spectrum and the time course of ASSD is not significantly affected by the presence of anti-Ro antibodies, althuough ILD seems to be more associated to anti-Ro antibodies. Despite higher prevalence ofILD in Ro positive group no difference in mortality was observed in respect to anti-Ro negative patients.References:[1]Cavagna L. Medicine (Baltimore) 2015 Aug;94(32):e1144[2]Marie I. Semin Arthritis Rheum. 2012 Jun;41(6):890-9Disclosure of Interests:None declared
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Favalli EG, Marchesoni A, Balduzzi S, Montecucco C, Lomater C, Crepaldi G, Talamini S, Bazzani C, Fusaro E, Priora M, Iannello A, Paolazzi G, Caporali R. FRI0273 EFFECTIVENESS AND RETENTION RATE OF SECUKINUMAB FOR PSORIATIC ARTHRITIS AND AXIAL SPONDYLOARTHRITIS: REAL-LIFE DATA FROM THE ITALIAN LORHEN REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Observational data on the use of secukinumab for the treatment of spondyloarthritides are still lacking. Large population-based registries that allow long-term follow-up have been increasingly used to investigate the performance of biologic drugs in a real life setting.Objectives:The aim of this study is to evaluate the effectiveness and the retention rate of secukinumab in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) patients in a real-life setting over a 3-year follow-up period.Methods:Data of all PsA and axSpA patients (diagnosed according to CASPAR and ASAS criteria, respectively) treated with secukinumab were prospectively collected in the Italian multicentric LORHEN registry. Effectiveness was measured as the mean change from baseline of Disease Activity in PSoriatic Arthritis score (DAPSA) in PsA and Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA patients. Rates of DAPSA remission and ASDAS inactive disease were also computed. The 3-year retention rate was calculated by the Kaplan-Meier method and compared between PsA and axSpA by a log-rank test. A descriptive analysis of reasons for discontinuation was performed.Results:The study population included 195 PsA (55.4% females, mean age 50.7 [±11.8] years, mean disease duration 10 [±7.8] years, mean baseline DAPSA 23.12 [±12.3]) and 94 axSpA (61.7% males, mean age 49.1 [±12.7] years, mean disease duration 10.4 [±9.4] years, mean baseline ASDAS 3.41 [±1.1]) patients who received secukinumab as first (26.5 and 33%, respectively) or subsequent biologic agent. Compared with baseline, the 3-, 6- and 12-month mean values of both DAPSA (12.6 [±9], 11.2 [±10.5] and 9.3 [±7.5], respectively) and ASDAS (2.23 [±0.9], 2.15 [±0.9], and 1.84 [±0.9], respectively) were significantly decreased (p<0.001 for all the timepoints). The 3-, 6-, and 12-month rates of remission/inactive disease were 15.5, 25.4, and 30.5% in PsA and 18, 23.7, and 28.6% in axSpA group, respectively. One- and 3-year retention rate (figure 1) were respectively 79.4% and 66.6% in PsA and 72.3% and 70.1% in axSpA patients, with no significant difference between the two groups (p=0.517). The most frequent reason for withdrawal was inefficacy in both PsA (n=41) and axSpA (n=20), whereas only 8 PsA and 6 axSpA patients discontinued secukinumab because of adverse events.Conclusion:Our data confirmed in a real-life setting the 1-year clinical efficacy and the 3-year survival of secukinumab in both PsA and axSpA. The safety profile of secukinumab was very favorable for both the indications. No significant differences were observed in the performance of secukinumab between ax-SpA and PsA.References:[1]Deodhar A, et al. Arthritis Research & Therapy; 2019.[2]Mease PJ, et al. RMD Open. BMJ Specialist Journals; 2018;4(2):e000723.[3]Baraliakos X, et al. Clin Exp Rheumatol. 2018 Jan;36(1):50–5.Disclosure of Interests:Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Antonio Marchesoni Speakers bureau: Abbvie, Pfizer, UCB, Novartis, Celgene, Eli Lilly, Silvia Balduzzi: None declared, Carlomaurizio Montecucco: None declared, Claudia Lomater Consultant of: Advisory board for Sanofi, Novartis, Abbvie, Gloria Crepaldi Consultant of: Advisory board for Sanofi and Celgene, Speakers bureau: BMS, MSD, Silvia Talamini: None declared, Chiara Bazzani: None declared, Enrico Fusaro: None declared, Marta Priora: None declared, Aurora Iannello: None declared, Giuseppe Paolazzi: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB
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Motta F, Ramoni V, Codullo V, Cesari S, Beneventi F, Johnsson H, Graham G, Montecucco C. SAT0280 IMPACT OF PLACENTAL FACTORS ON PREGNANCY AND FETAL OUTCOME IN SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic Sclerosis (SSc) is one of the rheumatic diseases burdened with obstetrical complications. An Italian multicenter study showed that women with SSc have a higher-than-normal risk of intrauterine growth restriction, preterm delivery, very-low birth weight babies and pregnancy should be discouraged in patients with severe organ damage. However, with a multidisciplinary management, patients with SSc can have successful outcomes1. Little is known about the pathogenesis of obstetrical complications, as studies on placenta are case reports or description of a few cases2,3.Objectives:The aim of this study was to analyze the placental alterations with a focus on the role of inflammation in the pathogenesis of obstetrical complications in SSc, including the study of the atypical chemokine receptor 2 (ACKR2), involved in immune modulation and known to be highly expressed in circulating leucocytes in SSc patients4-6.Methods:Eight SSc pregnant patients were compared with 16 patients with other rheumatic diseases (ORD) and 16 healthy controls (HC), matched for gestational age. Clinical data were collected. Placentas biopsies were obtained for histopathological analysis and immunohistochemistry for CD3, CD20, CD11c, CD68 and ACKR2. Frozen placenta samples from 4 SSc, 8 ORD and 8 HC were analyzed by qPCR for ACKR2 gene expression and proteins were extracted for multiplex assay for cytokines, chemokines and growth factors involved in angiogenesis and inflammation. Statistical analysis was performed with parametric or non-parametric tests depending on samples distribution.Results:The number of placental CD3 (p<0.05), CD68 (p<0.001) and CD11c+ (p<0.001) cells was significantly higher considering the group of patients affected by rheumatic diseases (SSc+ORD) compared to HC. The SSc group alone did not show significance due to the lower sample size. No differences were observed between groups in terms of vascular alterations or fibrosis. The percentage of stained area for ACKR2 and the ACKR2 transcripts levels were comparable between groups. Hepatocyte growth factor (HGF), involved in angiogenesis, was significantly increased in the group of rheumatic diseases patients (SSc+ORD) compared to HC (p<0.05), while the chemokine CCL5 was significantly higher in SSc patients compared to patients affected by ORD (p<0.05) and to HC (p<0.01). CCL5 levels directly correlated with the number of all inflammatory cells considered and higher levels were associated to histological villitis (p<0.01).Conclusion:The higher number of placental inflammatory cells and the alterations in the levels of HGF and especially CCL5 could play a role in the pathogenesis of the obstetrical complications in SSc. ACKR2 does not seem involved in the obstetrical complications of SSc.References:[1]Taraborelli M, et al. Arthritis Rheum. 2012[2]Ibba-Manneschi L, et al. Ann Rheum Dis. 2010[3]Doss BJ, et al. Hum Pathol. 1998[4]Graham GJ. Eur J Immunol. 2009[5]Martinez de la Torre Y, et al. Proc Natl Acad Sci U S A. 2007[6]Codullo V, et al. Ann Rheum Dis. 2011Disclosure of Interests:None declared
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De Stefano L, Bugatti S, Rossi S, Montecucco C, Manzo A. AB0027 B CELL SYNOVITIS IN RELATION TO DIAGNOSIS AND CLINICAL PHENOTYPE: COMPARISON BETWEEN RHEUMATOID AND PSORIATIC ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are both characterized by significant heterogeneity in terms of clinical presentation and outcomes. Furthermore, RA and PsA may share some overlapping features such as autoantibody-negativity, polyarticular involvement, response to certain therapies and pattern of joint damage. The pathobiological bases underlying the intra-disease heterogeneity and the inter-disease similiarities between RA and PsA are however unkown.Objectives:Aim of the current study was to investigate the relationship between the synovial immune phenotype and different clinical subsets in patients with RA and PsA.Methods:The study population included 96 patients undergoing ultrasound-guided synovial biopsy of the knee and serum sampling on the same day. Patients were recruited according to defined clinical subtypes: anti-citrullinated positive (ACPA) RA (n=26), ACPA-negative RA (n=32), polyarticular (≥5 involved joints) PsA (n=15), and oligoarticular PsA (n=23). Patients were compared for: (i) demographic and clinical features; (ii) synovial histopathological characteristics including CD68-positive infiltrating macrophages, CD3-positive T lymphocytes, CD20-positive B lymphocytes (semi-quantitative scores 0-3); (iii) serum levels of the lymphoid chemokine CXCL13 as a marker of germinal centre activity.Results:Collectively, ACPA-positive RA patients, ACPA-negative RA patients and patients with polyarticular PsA presented comparable demographic and clinical features including gender distribution, age, number of involved joints and levels of acute phase reactants. Patients with oligoarticular PsA were instead younger, more frequently males, and with lower levels of acute phase reactants. The degree of macrophage and T cell infiltration correlated with the erythrocyte sedimentation rate (rho 0.38, p=0.001 and rho 0.24, p=0.04 respectively) and C-reactive protein levels (rho 0.38, p=0.001 and rho 0.28, p=0.01 respectively) irrespective of diagnosis, and was significantly lower in oligoarticular PsA (Figure 1A,B). In contrast, the degree of B cell infiltration showed significant differences in relation to the disease subtype: the lowest levels were found in oligoarticular PsA, the highest levels in ACPA-positive RA, whilst ACPA-negative RA and polyarticular PsA presented with intermediate and comparable levels between the two extremes (Figure 1C). Serum levels of CXCL13 correlated with the synovial B cell score (rho 0.30, p=0.03) and, similarly to synovial B cell infiltration, were differentially increased according to the clinical phenotype, with again similarities between ACPA-negative RA and polyarticular PsA (Figure 1D).Figure 1.Conclusion:In patients with chronic inflammatory arthritis, synovial B cell infiltration and systemic markers of germinal centre activity are heterogeneously increased irrespective of disease diagnosis. ACPA-positive RA and oligoarticular PsA appear located at the extremes of a pathobiological continuum, whilst ACPA-negative RA and polyarticular PsA present with intermediate and comparable degrees of B cell involvement. Collectively, our findings open the interesting perspective of a tailored management of patients with inflammatory arthritis based on the disease pathotype rather than on clinical diagnosis.Disclosure of Interests:Ludovico De Stefano: None declared, Serena Bugatti Speakers bureau: Bristol-Myers Squibb, Sanofi, Lilly, Novartis, Pfizer, Abbvie, Silvia Rossi: None declared, Carlomaurizio Montecucco: None declared, Antonio Manzo Speakers bureau: Bristol-Myers Squibb, Abbvie, Pfizer
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Bogliolo L, Motta F, Del Vino P, Montecucco C, Bugatti S. OP0040 ANTI-CITRULLINATED PROTEIN AUTOANTIBODIES ARE ASSOCIATED WITH ONGOING SYSTEMIC BONE LOSS IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS TREATED ACCORDING TO THE PRINCIPLES OF TREAT-TO-TARGET AND TIGHT-CONTROL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:Anti-citrullinated protein antibodies (ACPA) are a major risk factor for local and systemic bone loss in patients with rheumatoid arthritis (RA). We previously demonstrated that early RA patients at disease presentation already show reduced systemic bone mineral density (BMD) in association with ACPA-positivity (1). Whether the negative impact of ACPA on bone continues over time despite treatment institution is however unknown.Objectives:To investigate longitudinally the course of systemic bone loss in patients with early RA after institution of treatment with disease modifying anti-rheumatic drugs (DMARDs) according to the principles of treat-to-target and tight-control.Methods:The study population included 100 consecutive early RA patients (<12 months of symptoms) recruited at our Early Arthritis inception cohort and already evaluated for systemic BMD at disease presentation before treatment start (1). After diagnosis, patients were prospectively followed-up at three-months intervals upon initiation of therapy with conventional synthetic DMARDs (methotrexate in 85% of the cases) aimed at the achievement of low disease activity (LDA, 28-joints disease activity score [DAS28] <3.2). BMD was re-assessed after 24 months at the lumbar spine (L1-L4) and hip by the same dual X-ray absorptiometry (DXA) equipment used at baseline. Differences in BMD from baseline were evaluated in relation to demographic and clinical variables (listed in Table 1).Table.Predictors of bone mineral density changes over 24 months% change in BMDlumbar spinetotal hipfemoral neckrprprpAge0.2690.0080.0690.500.2580.01female gender0.0850.42-0.0230.54-0.1210.23menopause0.1370.200.0670.530.0870.41disease duration0.0740.470.0440.670.0160.87cumulative DAS280.0180.860.0020.870.0110.91time to LDA0.1420.16-0.0230.76-0.0440.66time to remission0.0350.74-0.0020.97-0.0110.91ACPA-0.2510.010.1260.22-0.1300.04RF-0.1130.270.1110.280.0010.99months of bisphosphonates0.3680.0030.1710.090.2910.04cumulative steroids-0.1430.16-0.0070.78-0.0090.93months of bDMARDs-0.1630.11-0.0540.48-0.0630.54Results:The study population was mainly composed of females (84%), of whom 64.3% were in post-menopause; the mean (SD) age was 57.4 (13.5) years. Median (IQR) symptoms duration before treatment start was 14 (9-24) weeks. Fourty-three percent of the patients was ACPA positive. After 24 months of treatment, LDA was achieved in 79% of the cases, and remission in 46%; 17.7% of the patients had initiated a biological DMARD. At DXA re-scanning, the BMD at the lumbar spine and total hip remained largely unchanged, whilst at the femoral neck decreased from 0.726 g/cm2 to 0.713 g/cm2 (mean difference [SD] -0.013 [0.056], p=0.02). Predictors of BMD changes at different sites are shown in Table 1. The cumulative dose of prednisone was borderline significant for more BMD loss at the lumbar spine. Cumulative disease activity did not significantly affect BMD changes. Rather, ACPA-positive patients had higher percent changes at both the lumbar spine and the femoral neck. In multivariable analyses, ACPA remained associated with more BMD loss even when adjusting for confounders (age, gender, cumulative steroids, bisphosphonate treatment) (r -0.126, p=0.04 at the lumbar spine; r -0.126, p=0.04 at the femoral neck).Conclusion:Treatment of patients with early RA according to treat-to-target strategies prevents systemic bone loss. However, despite optimal disease control, ACPA positivity continues to be associated with progressive decline in systemic BMD.References:[1]Bugatti S et al. Arthritis Res Ther 2016;18:226.Disclosure of Interests:Laura Bogliolo: None declared, Francesca Motta: None declared, Paolo Del Vino: None declared, Carlomaurizio Montecucco: None declared, Serena Bugatti Speakers bureau: Bristol-Myers Squibb, Sanofi, Lilly, Novartis, Pfizer, Abbvie
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Gerosa M, Fredi M, Andreoli L, Chighizola C, Argolini LM, Donzelli D, Vojinovic T, Ramoni V, Bellis E, Trespidi L, Gazzola F, Ferrazzi E, Zatti S, Benvenuti F, Meroni PL, Franceschini F, Montecucco C, Cimaz R, Caporali R, Tincani A. SAT0207 ANTI-SSA/RO POSITIVITY AND CONGENITAL HEART BLOCK: OBSTETRIC AND FETAL OUTCOME IN A COHORT OF ANTI-SSA/RO POSITIVE PREGNANT WOMEN WITH AND WITHOUT AUTO-IMMUNE DISEASES FROM THREE ITALIAN TERTIARY REFERRAL CENTERS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:neonatal lupus syndrome (NLS) is an acquired disease caused by the trasplacental passage of anti-SSA antibodies. Congenital heart block (CHB) represents the most serious manifestation of NLS. The rate of CHB in Anti-SSA positive pregnant women ranges from 1 to 5% in different studiesObjectives:to retrospectively assess the prevalence of CHB in a cohort of anti-SSA positive pregnant women followed in 3 Italian tertiary centersMethods:pregnancies of anti-SSA positive women attending the pregnancy clinic of ASST Pini CTO/Policlinico Mangiagalli, Rheumatology Division of Spedali Civili, Brescia and Rheumatology Division of Ospedale S Matteo, Pavia from 2009 to 2019 were included. Patients underwent monthly clinical examination. Fetal heart rate was assessed weekly by Doppler ultrasound from 14thto 26thgestational week. On week 14 and 26, a fetal echocardiography was performed. A EKG was performed at birthResults:351 prospectively followed pregnancies in 292 anti-SSA/Ro positive women were included. Table 1 reports diagnosis. None of the prospectively followed pregnancies were complicated by complete CHB. Seven additional patients were referred to our clinics after diagnosis of CHB and were subsequently found to be anti-SSA positive, reporting no symptoms of diseases. Considering the 7 additional pregnancies, the incidence of CHB was 1.9%. We observed 3 neonates (0.8%) with cutaneous NLS and 1 case of transient increase of liver enzymes. In another neonate, a 1thdegree A-V block was found after birth. A complete analysis of maternal and fetal outcome was possible in 244 cases (Table 2) and compared with 3158 unselected healthy controls. Among these 244 cases, 65% were taking hydroxychloroquineTable 1.patients diagnosisn%Sjogren’s Syndrome58`20Systemic lupus erythematosus7626UCTD7425Asymptomatic Ro carriers5619Other2810292100Table 2.maternal and fetal outcomehealthy controls N=3158Anti-SSA/Ro ptsN=244P valuePrevious CHB n (%)2 (0.8)Anti-SSB pos n (%)46 (18.8)aPL pos n (%)49 (20)PregnancyLive births3158241Preeclampsia, n (%)43 (1.1)2 (0.8)nsDeliveryDelivery <37 wks, n (%) / < 34 wks n (%)401 (12.6) /201 (6)35 (15.6) / 14 (6)ns / nsCesarean Section, n (%)897 (29.3)115 (47.5)<0.001Conclusion:none of the patients prospectively followed in our centers before and during pregnancy developed complete CHB. If the 7 cases of anti-SSA positivity diagnosed after CHB detection were included in the analysis, the incidence of CHB was comparable to previous reports. Our data suggest that a strict follow up and proper treatment of anti-SSA positive patients with or without an autoimmune disease before and during pregnancy can reduce the risk of NLS. Further studies are warranted to confirm a possible protective role of anti-rheumatic treatments, including HCQReferences:[1]Fredi M. Front Cardiovasc Med. 2019Disclosure of Interests:Maria Gerosa: None declared, Micaela Fredi: None declared, Laura Andreoli: None declared, Cecilia Chighizola: None declared, Lorenza Maria Argolini: None declared, Davide Donzelli: None declared, Tamara Vojinovic: None declared, Véronique Ramoni: None declared, Elisa Bellis: None declared, Laura Trespidi: None declared, Federica Gazzola: None declared, Enrico Ferrazzi: None declared, Sonia Zatti: None declared, Fausta Benvenuti: None declared, Pier Luigi Meroni: None declared, Franco Franceschini: None declared, Carlomaurizio Montecucco: None declared, Rolando Cimaz: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB, Angela Tincani: None declared
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Abstract
Botulinum neurotoxins (BoNTs) are a growing family of bacterial protein toxins that cause botulism, a rare but often fatal animal and human disease. They are the most potent toxins known owing to their molecular architecture, which underlies their mechanism of action. BoNTs target peripheral nerve terminals by a unique mode of binding and enter into their cytosol where they cleave SNARE proteins, thus inhibiting the neurotransmitter release. The specificity and rapidity of binding, which limits the anatomical area of its neuroparalytic action, and its reversible action make BoNT a valuable pharmaceutical to treat neurological and non-neurological diseases determined by hyperactivity of cholinergic nerve terminals. This review reports the progress on our understanding of how BoNTs cause nerve paralysis highlighting the different steps of their molecular mechanism of action as key aspects to explain their extreme toxicity but also their unique pharmacological properties.
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Affiliation(s)
- O Rossetto
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - M Pirazzini
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - F Fabris
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - C Montecucco
- Department of Biomedical Sciences, University of Padova, Padova, Italy. .,Institute of Neuroscience, National Research Council, Padova, Italy.
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Gargani L, Codullo V, Argiento P, Moreo A, Pieri F, Mori F, Epis O, Moggi-Pignone A, Montecucco C, Valentini G, Matucci-Cerinic M, Sicari R, Ghio S, Bossone E, D'Alto M. P6478Resting and exercise pulmonary artery systolic pressure to rule out later development of pulmonary arterial hypertension in systemic sclerosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with systemic sclerosis (SSc) are at risk of developing pulmonary arterial hypertension (PAH), which is often diagnosed late when the benefits of vasoactive therapies are limited. The concept of exercise pulmonary hypertension as a possible transitional phase anticipating resting PAH has been assessed in several pathologies, but has not been endorsed by the latest European Guidelines, because not supported by sufficient data.
Purpose
To evaluate whether PASP values at rest and at peak exercise, estimated at echocardiography, could be predictors of further development of PAH.
Methods
Four hundred and twenty-nine SSc patients without a previous diagnosis of PAH, enrolled at 4 referral Centres, underwent standard exercise Doppler echocardiography with PASP estimation at rest and at peak stress. Patients were then followed-up to assess the development of PAH, as diagnosed by a complete diagnostic work-up including right heart catheterization. PAH was defined by pre-capillary pulmonary hypertension (mean pulmonary artery pressure ≥25 mmHg with pulmonary arterial wedge pressure ≤15 mmHg), without significant interstitial lung disease and/or left heart disease.
Results
During the median follow-up of 75 months (IQR 29–114), 16 patients developed PAH. A combined cut-off of ≥24 mmHg as resting PASP and ≥40 as peak PASP was identified as the best predictor of further development of PAH (see Figure). Both resting PASP and peak PASP were predictors of PAH at univariate analysis (resting PASP OR 1.13, 95% C.I. 1.07–1.19, p<0.0001; peak PASP OR 1.13, 95% C.I. 1.07–1.18, p<0.0001). At multivariate analysis, only peak PASP was independently associated to PAH development (OR 1.13, 95% C.I. 1.04–1.18, p<0.001). Only one patient among those with resting PASP <24 mmHg and peak PASP <40 mmHg (34.7% of the total population) developed PAH during the follow-up (after 10 years from normal exercise Doppler echocardiography).
Kaplan-Meier curves
Conclusions
Exercise increase in PASP is an independent predictor of later development of PAH in SSc. An increase in exercise PASP is frequent and is not necessarily associated with a later development of PAH, whereas the very high negative predictive value of a normal PASP both at rest and at peak exercise can be used in the clinical practice to confidently rule out about one third of patients.
Acknowledgement/Funding
Italian Ministry of Health (Ricerca Finalizzata 2011-2012)
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Affiliation(s)
- L Gargani
- Institute of Clinical Physiology - National Research Council, Pisa, Italy
| | - V Codullo
- University of Pavia, Rheumatology, Pavia, Italy
| | - P Argiento
- AO dei Colli-Monaldi Hospital, Cardiology, Naples, Italy
| | - A Moreo
- Niguarda Ca' Granda Hospital, Cardiology, Milan, Italy
| | - F Pieri
- Careggi University Hospital (AOUC), Florence, Italy
| | - F Mori
- Careggi University Hospital (AOUC), Florence, Italy
| | - O Epis
- Niguarda Ca' Granda Hospital, Rheumatology, Milan, Italy
| | | | | | - G Valentini
- AO dei Colli-Monaldi Hospital, Rheumatology, Naples, Italy
| | | | - R Sicari
- Institute of Clinical Physiology - National Research Council, Pisa, Italy
| | - S Ghio
- University of Pavia, Cardiology, Pavia, Italy
| | | | - M D'Alto
- AO dei Colli-Monaldi Hospital, Cardiology, Naples, Italy
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Bruni C, Ngcozana T, Braschi F, Pucci T, Piemonte G, Benelli L, Poli M, Suliman YA, Guiducci S, Bellando-Randone S, Balduzzi S, Grotts J, Denton CP, Rasero L, Montecucco C, Furst DE, Matucci-Cerinic M. Preliminary Validation of the Digital Ulcer Clinical Assessment Score in Systemic Sclerosis. J Rheumatol 2018; 46:603-608. [DOI: 10.3899/jrheum.171486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
Objective.To date, “healed/non-healed” and clinical judgment are the only available assessment tools for digital ulcers (DU) in patients with systemic sclerosis (SSc). The aim of our study is to examine a preliminary composite DU clinical assessment score (DUCAS) for SSc for face, content, and construct validity.Methods.Patients with SSc presenting at least 1 finger DU were enrolled and assessed with the Health Assessment Questionnaire–Disability Index, Cochin scale, visual analog scale (VAS) for DU-related pain, patient global DU status, and global assessment as patient-reported outcomes (PRO), and physician VAS for DU status (phyGDU) as an SSc-DU expert physician/nurse measure. The DUCAS included 7 DU-related variables selected by a committee of SSc DU experts and weighted on a clinical basis. Face validity was examined by consensus and partial construct validity was tested through convergent correlation with other measures of hand function, using Spearman’s correlations. A range of patients with SSc was examined. A linear regression model with backward stepwise analysis was used to determine the relationship of individual variables with the primary clinical parameter, phyGDU.Results.Forty-four patients with SSc (9 males, mean age 55 ± 15 yrs, mean disease duration 9.9 ± 5.8 yrs) were enrolled in the study. Overall DUCAS showed significant positive correlations with all abovementioned PRO (r > 0.4, p < 0.01). When all scores and scales were modeled, only DUCAS significantly predicted phyGDU (r = 0.59, R2 = 0.354, Akaike information criterion = 385.4).Conclusion.Preliminarily, we suggest that the DUCAS may be a new clinical score for SSc-related DU, having face and content validity and convergent/divergent correlations (construct validity). These early data suggest that this score deserves further evaluation.
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Manzo A, Bugatti S, Caporali R, Montecucco C. Histopathology of the synovial tissue: perspectives for biomarker development in chronic inflammatory arthritides. Reumatismo 2018; 70:121-132. [PMID: 30282438 DOI: 10.4081/reumatismo.2018.1057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 11/03/2017] [Indexed: 11/23/2022] Open
Abstract
The histopathological and molecular analysis of the synovial tissue has contributed to fundamental advances in our comprehension of arthritis pathogenesis and of the mechanisms of action of currently available treatments. On the other hand, its exploitation in clinical practice for diagnostic or prognostic purposes as well as for the prediction of treatment response to specific disease-modifying anti-rheumatic drugs is still limited. In this review, we present an overview of recent advances in the field of synovial tissue research with specific reference to the methods for synovial tissue collection, approaches to synovial tissue analysis and current perspectives for the exploitation of synovial tissue-derived biomarkers in chronic inflammatory arthritides.
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Affiliation(s)
- A Manzo
- Rheumatology and Translational Immunology Research Laboratories (LaRIT), Division of Rheumatology, IRCCS Policlinico San Matteo Foundation/University of Pavia.
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Abstract
The proliferative activity of bone marrow blasts was determined in 19 patients with acute leukemia during early induction therapy using in vitro tritiated thymidine (3H-TdR) cytoautoradiography and propidium iodide DNA flow cytofluorometry. Folloding 1-3 causes of treatment, the aliquot of bone marrow blasts in 9 patients, who later achieved remission or marrow aplasia, was reduced to a greater extent that of the remaining 10 patients who failed to respond. In the first group of patients, the 3H-TdR labeling index was increased by 259-653 % over the pretreatment value, whereas it was lower than 104 % of the pretreatment value in all but one unresponsive patient. Leukemic blast recruitment is conceivable. It might have facilitated remission by increasing the effectiveness of the antileukemic agents administered later.
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