High speed human action recognition using a photonic reservoir computer

The recognition of human actions in videos is one of the most active research fields in computer vision. The canonical approach consists in a more or less complex preprocessing stages of the raw video data, followed by a relatively simple classification algorithm. Here we address recognition of human actions using the reservoir computing algorithm, which allows us to focus on the classifier stage. We introduce a new training method for the reservoir computer, based on "Timesteps Of Interest", which combines in a simple way short and long time scales. We study the performance of this algorithm using both numerical simulations and a photonic implementation based on a single non-linear node and a delay line on the well known KTH dataset. We solve the task with high accuracy and speed, to the point of allowing for processing multiple video streams in real time. The present work is thus an important step towards developing efficient dedicated hardware for video processing.

POS1199 IS PSORIATIC ARTHRITIS A RISK FACTOR FOR SEVERE COVID -19 INFECTION? DATA FROM THE ARGENTINIAN REGISTRY SAR-COVID

Background

Comorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained.

Objectives

To describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confirmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA).

Methods

Cross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR / EULAR 2010 criteria), who had confirmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID)1 was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher’s test, Student’s test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed.

Results

A total of 129 PsA patients and 808 with RA were included. Clinical characteristics are shown in Table 1. Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. The frequency of NIAID≥5 was comparable between groups (PsA 19.5% vs RA 20.1%; p=0.976). (Figure 1).

Table 1.

Characteristics of patients with PsA and RA who presented COVID-19 in the SAR-COVID registry.

Psoriatic arthritis (n=129)Rheumatoid arthritis (n=808)P valueTotal (n=937)Age (years), mean (SD)51.7 (12.7)53.1 (12.9)0.23952.9 (12.9)Female72 (55.8)684 (84.7)<0.001756 (80.7)Comorbidities65 (50.4)355 (43.9)0.203420 (44.8) Obesity (BMI ≥30)19 (15.2)102 (13.4)0.692121 (13.7) Morbid obesity (BMI ≥40)1 (0.8)10 (1.3)111 (1.25) Hypertension35 (28.5)205 (26.8)0.783240 (27.0) Diabetes16 (13.0)67 (8.8)0.18883 (9.39) Dyslipidemia24 (19.5)102 (13.5)0.106126 (14.4) Cardiovascular or cerebrovascular disease5 (11.4)32 (3.9)0.03337 (4.2)Two or more comorbidities55 (42.6)219 (27.1)<0.001274 (29.2)Current smoking4 (3.6)60 (8.4)0.7964 (7.7)High disease activity0 (0)29 (3.8)0.02729 (3.23)Glucocorticoids treatment5 (20.0)95 (60.1)<0.001100 (54.6)Conventional DMARDs47 (36.4)443 (54.8)<0.001490 (52.3)Biologic DMARDs60 (46.5)193 (23.9)<0.001253 (27.0)JAK inhibitors4 (3.10)72 (8.9)0.03876 (8.1)Full recovery of COVID-19105 (84.0)644 (81.7)0.127749 (82.0)COVID-19 complications16 (12.5)68 (8.7)0.22784 (9.2)Death due to COVID-191 (0.8)34 (4.3)0.07435 (3.8)

Notes=values n (%) unless otherwise indicated; BMI: Body Mass Index; DMARDs: disease-modifying antirheumatic drugs; JAK inhibitors: Janus kinase inhibitors.

PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5; p=0.002), had more frequently hypertension (52.2% vs 23%; p=0.011) and dyslipidemia (39.1% vs 15%; p=0.017). In the multivariate analysis, age (OR 1.06; 95% CI 1.02–1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34; 95% CI 0.11–0.92) and biological DMARDs (OR 0.28; 95% CI 0.09–0.78) had a better outcome.

Conclusion

Although PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar. Most of the patients had mild SARS-CoV-2 infection and a low death rate.

References

[1]Beigel JH, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826.

Disclosure of Interests

None declared

POS1204 SARS-CoV-2 INFECTION AFTER VACCINATION IN PATIENTS WITH RHEUMATIC DISEASES FROM ARGENTINA

Background

Patients with rheumatic diseases (RD) have been excluded from SARS-CoV-2 vaccine trials. Though data appear to show safety and efficacy, mostly evidence remains in mRNA vaccines. However in our country, adenovirus and inactivated vaccines, as well as heterologous schemes are frequently used.

Objectives

To describe clinical characteristics and outcomes of SARS-CoV-2 infection after vaccination in patients with RD from de the SAR-CoVAC registry and to compare them with patients who got infected before vaccination. Additionally, factors associated with COVID-19 unfavorable outcome were assessed.

Methods

Adult patients with RD who have been vaccinated for SARS-CoV-2 were consecutively included between June 1st and December 21st, 2021. Confirmed SARS-CoV-2 infection (RT-PCR o serology) was reported by the treated physician. Infection after an incomplete scheme was defined when the event was diagnosed at least 14 days after first dose; and after a complete scheme when it occurred > 14 days after second dose. Homologous scheme is defined by two same doses of vaccine and heterologous by two different doses. Patients with previous SARS-CoV-2 infection were excluded. To compare SARS-CoV-2 infection characteristics in not vaccinated patients, subjects from the SAR-COVID registry, which includes patients with RD and SARS-CoV-2 infection, were matched 2:1 by gender, age and RD.

WHO-Ordinal Scale ≥5 was used to define unfavorable infection outcome. Descriptive statics, Chi2 test, Fischer test, T test and ANOVA were used.

Results

A total of 1350 patients from the SAR COVAC registry were included, 67 (5%) presented SARS-CoV-2 infection after vaccination. The later were mostly (72%) females with a mean age of 57 (SD 15) years old. The most frequent RD were rheumatoid arthritis (41%), psoriatic arthritis (12%) and systemic lupus erythematosus (10%). At vaccination, most of them (75%) had low disease activity or remission, 19% were taking steroids, 39% methotrexate, 27% bDMARDs and 6% JAK inhibitors.

A total of 11 (16%) patients had SARS-CoV-2 infection <14 days after the first vaccine dose, 39 (58%) after an incomplete scheme and 17 (25 %) following a complete one. In the incomplete scheme group, 59% received Gam-COVID-Vac, 31% ChAdOx1 nCov-19 and 10% BBIBP-CorV; and in patients with complete scheme 47%, 24% and 29%, respectively. No event was reported after a complete heterologous scheme. No significant differences regarding sociodemoghraphic characteristics, RD, disease treatment, type of vaccine and regimen was found between in those with infection and those without it.

After vaccination only 8 (12%) of the patients who got infected had an unfavorable course, 88% of them following an incomplete scheme (5 received Gam-COVID-Vac, 1 ChAdOx1 nCov-19 and 1 BBIBP-CorV) and one subject after a complete homologous Gam-COVID-Vac scheme. Having an unfavorable outcome of SARS-CoV-2 infection was associated to: male gender [63% vs 24%, p=0.036], older age [mean 70 years (SD 7) vs 55 years (SD 15), p=0.005], being Caucasian [100% vs 54%, p=0.018], higher education [mean 17 years (SD 4) vs 12 years (SD 4), p=0.010], the presence of comorbidities [100% vs 39%, p=0.001, having pulmonary disease [37% vs 5%, p=0.019], dyslipidemia [63% vs 17%, p=0.011] and arterial hypertension [63% vs 24%, p=0.036], RD, treatments, disease activity and types of vaccines received were comparable between groups.

When comparing patients with and without vaccination prior SARS-CoV-2 infection, those who received at least one dose of vaccine had less frequently severe COVID-19 (12% vs 24%, p=0.067) and presented lower mortality due to COVID-19 (3% vs 6%, p=0.498). However these differences did not reach statistical significance.

Conclusion

In the SAR-CoVAC registry 5% of the patients had SARS-CoV-2 infection after vaccination, most of them mild and 25% after a complete scheme. Any vaccine was associated with severe COVID-19. When comparing with non-vaccinated patients, those with at least one dose, had less frequently severe disease and died due COVID-19.

Disclosure of Interests

None declared

AB1101 PREVALENCE OF LONG COVID IN RHEUMATIC DISEASE PATIENTS: ANALYSIS OF SAR COVID REGISTRY

Background

Persistent symptoms after acute COVID have been described previously. Main symptoms reported are fatigue, arthralgias, myalgias and mental sickness. Definition and methods vary widely.1

Objectives

To asses prevalence and related factors to long COVID in a retrospective cohort of patients with rheumatic diseases from Argentina.

Methods

A total of 1915 patients were registered from August 18th, 2020 to July 29th, 2021. Patients > 18 years old, with rheumatic disease and confirmed infection by SARS-CoV-2 (antigen or RT-PCR) were included. Those dead, with unknown outcome, wrong date or missing data were excluded. Demographic data, comorbidities, rheumatic disease, and characteristics of SARS-CoV-2 infection were recorded.

Long COVID was defined according to NICE guidelines (persistent symptoms for more than 4 weeks, without alternative diagnosis). Long COVID symptoms were defined by rheumatologist. Severity of infection was classified according to WHO ordinal scale.

We used descriptive statistics, univariate model (Student’s test, chi square test, ANOVA) and multivariate logistic regression analysis.

Results

230 (12%) had long COVID. Median age was 51 (IQR 40-61]) years, 82% were females, 51% were not caucasian. Median of education was 13.3 years (IQR 12 – 16), 79 % had private health insurance and 55 % were employed. Nearly half (n=762, 46%) had comorbidities, the most prevalent was hypertension (n=396, 24%).

The most frequent rheumatic diseases were rheumatoid arthritis (n=719, 42%) and systemic lupus erythematosus (n=280, 16 %). Most were in low activity/remission (79%), used Conventional DMARD (n=773 patients, 45%) and steroids (n=588, 34%) at low dose (n=415, 71%).

Main laboratory findings were abnormal D-dimer (n=94, 28%) and leukopenia (n=93, 26%). Most patients had a WHO ordinal scale < 5 (n=1472, 86%). Median of hospitalization at intensive care unit (ICU) was 8 days [IQR 5, 13]. Treatment for SARS-CoV-2 infection (steroids, anticoagulation, azithromycin, convalescent plasma) was used in 461 (27%) patients.

Most of long COVID (n= 152, 69%) reported 1 symptom, the most frequent was fatigue (n= 55, 22%). Figure 1.

Univariate analysis is presented in Table 1. In multivariate logistic regression analysis non-caucasian ethnicity OR 1.44 (1.07-1.95), years of education OR 1.05 (1-1.09), treatment with cyclophosphamide OR 11.35 (1.56-112.97), symptoms of COVID – 19 OR 13.26 (2.75-242.08), severity scale WHO ≥ 5 OR 2.46 (1.68-3.57), and ICU hospitalization days OR 1.09 (1.05-1.14) were factors associated to long COVID.

Table 1.

Univariate analysis of long COVID syndrome in SAR – COVID registry

VariableAcute COVID n=1486Long COVID n=221P valueAge, years, median [IQR]51 [40, 60]54 [42, 62]0.032Caucasian, n (%)744 (48)132 (53)0.227Female sex, n (%)1242 (80)215 (86)0.066Education, years, median [IQR]12 [10, 17]13 [12, 16]-Private health insurance, n (%)1161 (79)181 (82)0.325Smoking, n (%)381 (25)71 (29)0.224Comorbidities, n (%)650 (45)108 (52)0.066Dyslipidemia, n (%)173 (12)39 (19)0.008Hypertension, n (%)332 (23)60 (29)0.053Low activity/remission disease, n (%)1140 (80)179 (77)1Rheumatoid arthritis, n (%)623 (42)96 (42)1Systemic lupus erythematosus, n (%)243 (16)37 (16)0.996DMARD, n (%)664 (45)109 (47)0.486Cyclophosphamide, n (%)3 (0.2)3 (1)0.035Rituximab, n (%)19 (1)9 (34)0.008Lymphocyte66 (23)19 (30)0.011<1.500 / mm3, n (%)Ferritin > 2000 ng/ml, n (%)32 (11)16 (25)0.011ICU hospitalization, days,7 [4, 10]10 [8, 24]<0.001median [IQR]Treatment for COVID-19, n (%)394 (27)91 (41)<0.001

Conclusion

Prevalence of long COVID was 12%. Non-caucasian ethnicity, higher education, treatment with cyclophosphamide, symptoms of COVID – 19, severe disease and ICU hospitalization days were related to long COVID.

References

[1]Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, Riera R. Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review. Int J Clin Pract.

Disclosure of Interests

None declared

AB1483 ASSOCIATION BETWEEN THE DECREASE OF CAPILLAR DENSITY IN THE CAPILLAROSCOPY AND THE DIAGNOSIS OF SYSTEMIC SCLEROSIS PATIENTS WITH RAYNAUD

Background

Videocapillaroscopy (VC) has become a widely used tool due to its low cost, accessibility and no invasive nature. PANLAR study group proposes a semi-quantitative method to inform it, which includes four grades to categorize capillary density (methods). Previous studies found that capillary density is associated with microvascular damage, predicts disease progression and organ affection in systemic sclerosis (SSc) and can be useful as a follow-up tool (1-5).

Objectives

Describe the associations between the different patterns and grades of capillary density loss and the SSc diagnosis.

Methods

A cross sectional study was designed using clinical records, including outpatients attending to a VC consult between the March and October 2021. Descriptive data regarding patients demographics, presence of rheumatologic diagnosis and treatment was registered. The VC was performed by an experienced rheumatologist (RTR) (DinoLite), with a 200x amplification. Capillary density loss (CDL) was scored based on PANLAR recommendations: Grade 0 (no loss), Grade I (7-9 capillaries / lineal mm), Grade II (4-6 capillaries / lineal mm), Grade III (< 4 capillaries / lineal mm).

Descriptive statistics were performed and data was compared using Student´s T test, Mann-Whitney, Chi2 or exact Fisher´s test depending on the type of data and its distribution. A p value < 0.05 was considered as significative.

Results

One hundred and one patients were included, 91 (91%) female, mean age 43 years (SD 13.9), 72 (71,3%) had raynaud phenomenon (RP), with a mean evolution of 1 year (IQR 0.5-3.5). Rheumatologic diagnosis was: 19 rheumatoid arthritis (RA), 16 SSc, 11 systemic lupus erythematosus (SLE) and 27 no diagnosis, including 2 with digital necrosis and one with endocarditis suspicion. VC was normal in 40 (39.6%) patients, 34 (33.7% had non-specific findings, and 26 (26%) SD pattern. In the latter, the pattern was 2 were early pattern, 11 active and 13 late.

SD pattern was associated with SSc diagnosis, and the use RP medication (both p<0,001). Three patients with inflammatory idiopathic myopathy (IIM), 2 SLE, 2 primary sjögren syndrome (pSS) and 2 without diagnosis had also this pattern. LCD was found in 27% of the patients, and Grade III was associated with SSc diagnosis being 14 times more frequent compared with non-SSc. [Table 1]

Table 1.

Capillary density loss presence and grades in SSc vs non-SSc

VariableSScNo-SScOR (95%CI)p valueCDL – n (%)12 (75)15 (17.6)14 (3.9-49.4)0.0001Grade I – n (%)7 (8.2)4 (25)3.8 (0.9-14.6)0.07Grade II – n (%)3 (18.8)6 (7.1)3 (0.6-13.8)0.1Grade III – n (%)4 (25)2 (2.4)13.8 (2.2-83.8)0.005

Ssc (systemic sclerosis), CDL (capillary density loss),

Conclusion

CDL was present in almost 1/3 of non selected patients attending to a VC study, and was strongly associated with SSc diagnosis. Future studies including this outcome can bring new data regarding microvascular damage and its implications.

References

[1]Emrani Z, Karbalaie A, Fatemi A, Etehadtavakol M, Erlandsson B-E. Capillary density: An important parameter in nailfold capillaroscopy. Microvasc Res. 2017 Jan;109:7–18.

[2]Gheorghiu AM, Oneata R, Ancuta I, Enuica A, Linte O, Macovei L, et al. Capillary loss reflects disease activity and prognosis in patients with systemic sclerosis. Exp Ther Med. 2020 Oct;20(4):3438–43.

[3]Hofstee HMA, Vonk Noordegraaf A, Voskuyl AE, Dijkmans BAC, Postmus PE, Smulders YM, et al. Nailfold capillary density is associated with the presence and severity of pulmonary arterial hypertension in systemic sclerosis. Ann Rheum Dis. 2009 Feb;68(2):191–5.

[4]Hudson M, Masetto A, Steele R, Arthurs E, Baron M. Reliability of widefield capillary microscopy to measure nailfold capillary density in systemic sclerosis. Clin Exp Rheumatol. 2010 Oct;28(5 Suppl 62):S36-41.

[5]Wildt M, Wuttge DM, Hesselstrand R, Scheja A. Assessment of capillary density in systemic sclerosis with three different capillaroscopic methods. Clin Exp Rheumatol. 2012 Apr;30(2 Suppl 71):S50-54.

Disclosure of Interests

None declared

AB0568 CHRITHIDIA LUCILAE IMMUNOFLUORESCENCE PRESENCE IN SYSTEMIC LUPUS ERYTHEMATOSUS AND ITS ASSOCIATION WITH POSITIVE CHAGAS TESTS

Background

Systemic lupus erythematosus (SLE) is characterized by the presence of auto-antibodies, including anti-double strained DNA (dsDNA), which are highly specific for the disease diagnosis and its follow up. Indirect immunofluorescence (IIF) using chritidia luciliae (CL) as the antigenic substratum, is the most widely used method to detect it, and its positivity is defined with the staining of the kinetoplast and/or the nucleus. CL is a flagellated parasite, included in trypanosomatidae family, which also includes trypanosoma cruzi, the cause of Chagas Disease (CD). Some studies suggest that membrane and flagellum fluorescence (considered ‘atypical’ staining) could be related with positive CD serology.

Objectives

Describe the prevalence of positive IIF-CL images and its association with positive CD test in SLE patients.

Methods

A cross sectional study was designed including consecutive outpatients with SLE diagnosis (SLICC criteria), in which anti-dsDNA antibodies was requested to monitor disease activity. At the same time, two serologic CD tests were performed, since they improve sensibility to detect the disease.

Anti-dsDNA by IIF were performed by an experienced laboratory biochemistry blinded to patients clinical data. Pregnant patients and those ≤ 18 years old were excluded from this analysis.

Standard descriptive analysis was performed, data was compared by exact fisher test or chi2, student’s T test or Mann Whitney. A p value < 0.05 was considered as significative.

Results

Thirty five patients were included, 33 (94.3) female, median age 38 (IQR 31-48), with 20 (57.1) patients being from middle-low socioeconomic status (measured by Graffar score). Twenty-six (74.3) patients were receiving glucocorticoids, 28 (80) hydroxychloroquine, 5 (14.3) azathioprine, 12 (34.3) mofetil mycophenolate, 5 (14.3) cyclophosphamide and 4 (11.4) rituximab.

Twelve (34.4) had positive anti-dsDNA test, with atypical staining in membrane and flagellum 31 (88.9), only membrane 4 (11.4) and 9 (25.7) only basal body. One patient had previous chronic CD diganosis without specific treatment.

Five (14.3) CD serologies were positive, and 1 had undefined result. This group of patients had positive staining in membrane and flagellum of CL. No other atypical CL staining images were found. (Table 1)

Table 1.

CL staining in CD positive v negative serology

Chritidia luciliae StructureCD negative (n = 29)CD positive (n = 5)p valueMembrane and flagellum – n (%)25 (86.2)5 (100)0.51Only Membrane – n (%)4 (13.8)00.51Basal body – n (%)7 (24.1)1 (20)*0.66

* undefined result

Conclusion

Although we could not find a statistical association between atypical CL staining and positive CD serology, this could be due to the low number of patients included in the study since all the patients with positive CD serology had a positive staining in CL-IIF. A trained biochemistry operator is necessary to avoid false positive tests in regions with high prevalence of CD.

Disclosure of Interests

None declared

AB0207 SOME TARGET JOINTS PERSIST SWOLLEN ACROSS THE FOLLOW-UP IN RHEUMATOID ARTHRITIS: RESULTS FROM A REAL LIFE REGISTRY

Background

Rheumatoid arthritis (RA) is an inflammatory chronic disease, affecting peripheral joints. For the assessment of these joints, rheumatologists use mostly 28 joint swollen and tender count. Although there has been a development of new drugs and therapeutic strategies, there is new information (1) regarding the persistence of some joints that seem to be refractory to treatment.

Objectives

The aim of this study is to describe the pattern of swollen joint affection and its change during followup in real-life RA patients from a rheumatology clinic registry.

Methods

RA patients from an outpatient registry were included if they fulfilled ACR-EULAR 2010 criteria, had ≥ 18 years old, and attended between October 2010 to September 2021. Only those who a 28-joint swollen count available performed by an experienced rheumatologist (EB) in ≥ 5 visits were included. Each joint from the 28-joint count was analyzed individually, the percentage of swollen affection at baseline, last registered visit and during the follow-up was registered. Descriptive statistical analysis and comparisons was performed, depending on the type of data and its distribution.

Results

403 patients with RA diagnosis were in the registry, 247 (61%) had descriptive 28-joint count, from which 154/247 (62.3%) had ≥ 5 visits and were finally included. When comparing those with < 5 with ≥ 5 visits, the latter had more bDMARD/tsDMARD treatment at baseline (16.9% v 6.5%, p = 0.01). In 154 patients, the mean period between visits was 6.7 months (SD +/- 5.8), the mean follow-up was 5.8 years (SD +/- 3.1), and the mean of visits per patient was 13 (DS +/- 8.8). At baseline the most affected swollen joints were 35.7% right wrist, 35.1% Left Wrist, 35% 2nd right MCP, 32.5% 3rd right PIP. At the last registered visit, the same joints were the most affected, and the percentage of affection persisted across the follow-up. [Figure 1]. When the change from baseline to the last registered visit was analyzed for other variables, a significative improvement was found (baseline v last visit, ESR-DAS28: 3.8 v 3, p = 0.0001, CRP-DAS28: 3.5 v 2.7, p = 0.001).

Figure 1.

Percentage of swollen joint affection at baseline, final registered visit and average followup

Conclusion

In this registry, some swollen joints were persistently affected across the follow-up, and did not improve from baseline to the last registered visit. However, the burden of the disease improved, measured by DAS28 or its individual components. The improvement of other swollen joints and other components of DAS28 can be the reason. The detection and local treatment (vg: intra-articular injections) of this persistent swollen joints could be the better approach to this issue. Weaknesses of this study: a possible bias in the included patients (they were from single clinic), joint assessment not blind and performed by a single rheumatologist, patients included could be more severe since they were more frequently bDMARD/tsDMARD users.

References

[1]Heckert S, Bergstra SA, Matthijssen X, et al POS0097 JOINT INFLAMMATION TENDS TO RECUR IN THE SAME JOINTS DURING THE RHEUMATOID ARTHRITIS DISEASE COURSE Annals of the Rheumatic Diseases 2021;80:259.

Table 1.

Change from baseline to the last registered visit (n = 154)

VARIABLEBasalFinalp =Methotrexate – n (%)89 (57.8)119 (77.3)0.0001Leflunomide – n (%)31 (20.1)37 (24)0.3Prednisone – n (%)57 (37)75 (48.7)0.01bDMARD / tsDMARD – n (%)26 (16.9)49 (31.8)0.0001Swollen Joints – X (SD)4.64 (4.8)3.03 (3.8)0.0001Tender Joints – X (SD)3.9 (4.5)2.49 (3.6)0.002VAS global (mm) – X (SD)38.5 (24)31.04 (22.7)0.004VAS physician (mm) – X (SD)35.6 (26.4)24.2 (22.4)0.0001ESR (mm/1h) – X (DS)33.7 (23.2)27.3 (23.2)0.01CRP (mg/dl) – X (DS)3.7 (5.7)1.7 (2.6)0.02ESR-DAS28 – X (DS)3.8 (1)3 (1.1)0.0001CRP-DAS28 – X (DS)3.5 (1)2.7 (1.1)0.001ESR-DAS28≤ 2.6 – n (%)22 (14.3)50 (32.5)0.00012.7-3.2 – n (%)16 (10.4)16 (10.4)13.3-5.1 – n (%)78 (50.6)43 (27.9)0.0001≥ 5.2 – n (%)9 (5.8)8 (5.2)0.8

Disclosure of Interests

None declared

POS1188 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES: COMPARISON OF DATA FROM THE ARGENTINE REGISTRY (SAR-COVID), WITH THE LATIN AMERICAN AND GLOBAL REGISTRY (GLOBAL RHEUMATOLOGY ALLIANCE)

Background:

SARS CoV-2 infection has recently burst onto the global scene, and the knowledge of the course of this infection in patients with rheumatic diseases receiving immunomodulatory treatment is still insufficient. The Argentine Society of Rheumatology (SAR) designed a national registry called SAR-COVID in order to get to assess our reality.

Objectives:

To identify the particular characteristics of patients with rheumatic diseases and COVID-19 in Argentina (SAR-COVID Registry), and to compare them with the data reported at the Latin American and Global level (Global International Alliance Rheum-COVID Registry).

Methods:

A national, multicenter, prospective and observational registry was carried out. Patients older than 18 years, with a diagnosis of rheumatic disease and SARS-CoV-2 infection by PCR or serology, were included between August 13, 2020 and January 17, 2021. Demographic data, underlying rheumatic disease (activity of the disease, current treatment), comorbidities, clinical-laboratory characteristics of the SARS-CoV-2 infection, as well as received treatments (pharmacological, oxygen therapy / ventilatory support) and outcomes (hospitalization, mortality) were recorded. The characteristics of the included patients were compared with the data reported at the Latin American and global level. Descriptive statistics were performed. Comparisons between groups were made using ANOVA, chi2 or Fisher’s test, according to the type of variable.

Results:

Four hundred sixty-five patients from Argentina, 74 patients from Latin America and 583 from the rest of the world were included, mostly women (79.6%, 73% and 71% respectively), with a mean age of 50.2 (SD 15.3), 53.5 (DE 15.6) and 55.8 (15.5), years respectively. The most frequent rheumatic diseases in the three groups were rheumatoid arthritis (43.9%, 35%, and 39%) and systemic lupus erythematosus (16.1%, 22%, and 14%) (Table 1).

In Argentina, fewer patients received specific pharmacological treatment for COVID-19 (40.9%, 68% and 43% respectively, p <0.0001), and there was a lower requirement of NIMV / IMV (Non-Invasive Mechanical Ventilation/Invasive Mechanical Ventilation) than in the rest of Latin America and the world (10.5% vs 31% vs 13%, p <0.0001).

Hospitalization was lower in Argentina than in the rest of Latin America (37.4% vs 61% p 0.0002) and of the world (37.4% vs 45% p 0.0123), and mortality was numerically lower in Argentina, but without statistically significant differences between the three groups (6.9%, 12% and 11%; p 0.6311). Most of the patients, (86.9%) did not present any complications in Argentina, with a statistically significant difference with the rest of the groups (62% and 77%, p <0.0001) (Graph 1).

Conclusion:

The patients with rheumatic diseases and SARS-CoV-2 infection reported in this argentinian registry received less specific pharmacological treatment for COVID-19, presented fewer complications and required less ventilatory support, than those reported in the Latinoamerican and Global registry. However, no statistically significant differences were observed in terms of mortality.

Graph 1.

Main outcomes and evolution of patients with rheumatic disease and COVID-19.

References:

[1]Stokes, Erin K, Zambrano, Laura D, Anderson, Kayla N, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep; 69(24): 759-765, 2020 Jun 19.

[2]Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm síndromes and immunosuppression. Lancet 2020;395:1033–4.

[3]Gianfrancesco M, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859–866.

[4]Manuel F. Ugarte-Gil, et al. Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America. Global Rheumatology. Septiembre 2020.

Disclosure of Interests:

Alvaro Andres Reyes Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Gelsomina Alle Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Tanten Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Marina Scolnik Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Enrique Soriano Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Berbotto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Maria Haye Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, María Julieta Gamba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Nieto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Mercedes García Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Veronica Savio Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana Gonzalez Lucero Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Paula Alba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Lorena Takashima Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, FABIAN RISUEÑO Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana CASALLA Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Natalia Cucchiaro Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Ana Bertoli Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Sabrina POrta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carla Maldini Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Gallo Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Cecilia Goizueta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Eugenia Picco Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Quintana Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Karen Roberts Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carolina Ayelen Isnardi Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Pons-Estel Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”

The MAastricht Instrument for Sustainable Employability – Italian version: a validation study

Background

Health promotion and age management at work are top priorities for governments and employers. To promote sustainable employability (SE) in ageing societies is more necessary than ever. In the Netherlands, an instrument for tapping the employee perspective on SE (MAISE-NL), has recently been developed. This study aims to validate the Italian version of MAISE (MAISE-IT).

Methods

The MAISE-IT (a translated and adapted version of the MAISE for the Italian population), the Work-Health Balance questionnaire and demographics (age, gender, education, and occupational activity) were answered online by a total of 455 respondents (328 public administration workers and 127 respondents recruited on social networks). Construct and criterion validity were tested by CFA, reliability and correlational analyses and subgroup analyses through ANOVAs.

Results

The CFA analysis provided evidence of the MAISE-IT to consist of 12 scales divided over five areas: (1) Meaning of SE; (2) Level of SE; (3) Factors affecting SE; (4) Overall responsibility for SE; and (5) Responsibility for factors affecting SE. Construct validity, reliability and criterion validity were good. Italian employees reported a moderately high level of SE. They considered employers as being somewhat more responsible for SE than employees.

Conclusions

This study showed the validity of the MAISE-IT in the Italian context. The MAISE-IT is valuable to assess employees' needs in order to develop SE interventions that align with the employee perspective. Specific policy regulations and campaigns should be developed to make employees more aware of opportunities to increase their SE.

Key messages

The MAISE-IT can be used to measure the meaning and level of SE, factors affecting SE and responsibility for SE, in order to develop group level SE interventions. As employees in different contexts might have different ideas on SE, an instrument that measures perspectives on different SE dimensions separately is innovative.

FRI0605-HPR MORTALITY AND SURVIVAL IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS IN ARGENTINA. A MULTICENTER STUDY ON BEHALF GESAR-LES

Background:

The mortality rate in patients with systemic lupus erythematosus (SLE) is 2–3 times higher than in the general population. However, survival in these patients has improved significantly and is currently 95% at 5 years according to different studies. Since the last 20 years, there are no new reports on this issue in Argentina.

Objectives:

To analyze the factors associated with mortality, survival and causes of death in patients with SLE.

Methods:

Longitudinal - multicenter study, in which 10 rheumatology centers of Argentina participated. Patients with SLE (ACR 1997 and / or SLICC 2012 criteria) with a minimum follow-up of 6 months monitored between January 2008 and December 2018 were included. Demographic, clinical, laboratory, therapeutic variables (treatments received during the evolution of the disease and within 60 days prior to death or last control); mortality, causes of death and survival at 5, 10 and 20 years were evaluated. Statistical analysis: descriptive statistics, Kaplan-Meier survival curves and Cox regression model.

Results:

Three hundred and eighty two patients were included; 90% women and 82% mestizos. The mean of evolution time of SLE was 4.1 ± 6.7 years. The mean age at the last control or death was 37.2 ± 12.7 years, SLEDAI 3.2 ± 4.2 and SLICC 1.2 ± 1.9.

Mortality was 12% (95% CI [8-15]) and the causes of death were: Infections (27), cardiovascular disease (6), SLE activity (3), catastrophic antiphospholipid syndrome (2) and other causes (8). Using the variables associated with mortality in different Cox regression models, the variables that increased the risk of death significantly were: renal involvement (RR 3.3), cardiac involvement (RR 2.7), central nervous system involvement (RR 2.1), arterial thrombosis (RR 2.3), hyperlipemia (RR 2.4), number of infections (RR 1.2) and last SLEDAI (1.1).

The time of HCQ use greater than 36 months decreased the risk of death in this cohort by 40% (p 0.03). Prednisone (maximum dose and time) was not associated with mortality (p NS). When analyzing the last treatment and adjusting it for final SLEDAI, HCQ was a mortality protection factor (RR 0.4) while the use of cyclophosphamide alone or associated with prednisone was a risk factor for death (RR 5.2).

Significant differences were found when analyzing the causes of death according to the SLE evolution time (p 0.017): patients who died from infection had less evolution time (Me 2.25 years), than those who died due to cardiovascular causes (Me 10 years) or SLE activity (Me 15 years). In this cohort of patients, survival was 93% at 5 years, 88% at 10 years and 72% at 20 years.

Conclusion:

Mortality in this series of patients was 12% and infection was the leading cause of death. The use of HCQ for a period greater than 36 months, decreased the risk of death 40%.

Disclosure of Interests:

None declared

Phase II study of bevacizumab and nitrosourea in patients with recurrent malignant glioma: A multicenter Italian study

2012

Background: Bevacizumab (BV) has shown a promising activity in recurrent malignant gliomas (MG) in combination with irinotecan. Few data are available on the combination of bevacizumab and nitrosoureas, that represent the standard cytotoxic option at recurrence. Methods: In this ongoing phase II study patients with MG recurrent after surgery, radiation therapy, and temozolomide are eligible. The treatment consists of an induction phase with BV at 10 mg/kg intravenously on day 1 and 15 and fotemustine (FTM) (a nitrosourea with elevated lipophilic properties) at 75 mg/m2 intravenously on day 1 and 8, followed after a 3-week interval by a maintenance phase with BV at 10 mg/kg i.v. and FTM 75 mg/m2 i.v. every 3 weeks until tumor progression or unacceptable toxicity. Patients undergo clinical and MRI assessment 1 month after the start of treatment and thereafter every 2 months. Monitoring of CBV with perfusion MRI is performed in selected centers. The co-primary endpoints are objective response rate (ORR), based on Mc Donald's criteria (CR + PR) and progression-free survival at 6 months (PFS6), with secondary endpoints of safety time to tumor progression (TTP) and overall survival. Results: From April 2008 to December 2008, 34 patients were enrolled and 31 (22 glioblastomas and 9 anaplastic gliomas) are evaluable for response. Overall response rate (2 CR and 9 PR) was 35% (glioblastomas 33%, anaplastic gliomas 41.5%). Median time to maximal response was 1 month. Steroids were reduced in 50% of patients. Sixteen of 31 patients progressed with a TTP of 2.6 months (1–8.5). Patterns of progression were local in 10/16, local + leptomeningeal spread in 3/16 and gliomatosis in 3/16. Fifteen patients are free of tumor progression (from 2 to 8 months). Toxicities included grade III-IV neutropenia in three patients, grade III-IV piastrinopenia in five, and grade III thrombosis in two. Seventeen patients developed mild to moderate fatigue, six arterial hypertension, and three grade I intratumoral haemorrhage. Conclusions: Combination of bevacizumab and fotemustine in recurrent malignant gliomas is safe and promising. Updated results, monitoring of CBV with perfusion MRI, and correlations between MGMT promoter methylation and response/outcome will be presented.

No significant financial relationships to disclose.

MRI activity and neutralising antibody as predictors of response to interferon beta treatment in multiple sclerosis

OBJECTIVE

To prospectively validate MRI activity and neutralising anti-interferon antibody (NAb) during the first 6 months of interferon beta treatment as response indicators in multiple sclerosis (MS).

METHODS

Patients with relapsing-remitting MS were followed during the first 2 years of treatment. Neurological assessments were performed every 3 months or when a relapse was suspected. MRI scans performed at baseline and at 3, 4, 5 and 6 months after the start of treatment were assessed centrally for disease activity: new T2 or gadolinium enhancing T1 lesions. NAb were assessed using the MxA protein assay; positivity was defined as two consecutive titres >or=20 NU/ml. We evaluated the predictivity of an active scan, NAb positivity, or both, during the first 6 months of treatment, on the occurrence of clinical disease activity in the following 18 months.

RESULTS

147 patients were assessed at 16 centres. Predictivity parameters (with confidence intervals) were as follows: active scan, sensitivity (SN) 52% (34-69%), specificity (SP) 80% (65-91%), negative predictive value (NPV) 73% (58-77%), positive predictive value (PPV) 62% (42-79%), p = 0.002; NAb positivity, SN 71% (45-88%), SP 66% (55-76%), NPV 92% (82-97%), PPV 29% (16-45%), p = 0.01; active scan and NAb positivity, SN 71% (38-91%), SP 86% (73-94%), NPV 94% (86-98%), PPV 50% (29-70%), p = 0.0003.

CONCLUSIONS

MRI activity and NAb occurrence during the first 6 months of interferon beta treatment were reliable predictors of long term clinical response, particularly when combined. Patients with negative predictors showed a less than 10% risk of developing clinical activity. Patients with positive predictors showed a 50% risk of further clinical activity. These patients need to be followed carefully with further MRI and NAb tests.