[Primary open angle glaucoma and sleep apnea syndrome: A review of the literature]

The relationship between glaucoma and Obstructive Sleep Apnea Syndrome (OSAS) has long been discussed, with conflicting study findings. OSAS appears in the most recent studies to be more of an aggravating factor than an independent risk factor for glaucoma. Patients with OSAS may develop a more rapid progression of primary open-angle glaucoma (POAG). OSAS may damage the optic nerve not only by increasing the intraocular pressure (IOP) but also by altering the blood supply to the optic nerve as shown by more recent work with OCT-Angiography. Although the systemic benefits of Continuous Positive Airway Pressure (CPAP) have been demonstrated, few studies have evaluated its effect on the optic nerve. CPAP might act on glaucomatous neuropathy by improving the blood supply to the optic nerve. The study of this mechanism of action might provide new insights into the relationship between OSAS and glaucoma.

Adherence to continuous positive airway pressure treatment in a cohort of elderly adults with newly diagnosed obstructive sleep apnea

PURPOSE

To evaluate adherence to continuous positive airway pressure (CPAP) treatment in elderly patients newly diagnosed with obstructive sleep apnea syndrome (OSAS).

METHODS

Consecutive patients ≥ 70 years attending one of the participating centers, requiring CPAP treatment and agreeing to participate, were included. Mean hours of CPAP during the first 5 months of treatment defined adherence as CPAP ≥ 4 h/day on 70% of nights over a 30-day period.

RESULTS

From January 2014 to April 2019, 262 patients aged between 76.7 and 87.7 years (mean age, 82.6 years) were included and fully evaluated; 224 (85.5%) were adherent. Mean adherence time was 6.9 h in adherent patients, vs 2 h in non-adherent patients (p < 0.0001). Compared to non-adherent patients, adherent patients tended to have higher baseline AHI without reaching statistical significance (44.7 vs 39.5, p = 0.0913). They less frequently presented with dementia (3.7% vs 21.6%, p < 0.0001). The somnolence (ODSI and Epworth), nocturia, and depression (QD2A) scores of adherent patients improved significantly from baseline to the fifth month: ODSI decreased from 7 to 3.7 (p < 0.0001), Epworth from 8.7 to 6.2 (p < 0.0001), nocturia from 6.6 to 4.1 (p = 0.0015), and QD2A from 3.7 to 3 (p = 0.0025). Many more patients in the non-adherent group used nasal plugs than in the adherent group (14.7% vs 2.1%, p = 0.0006).

CONCLUSION

The present real-world study showed the ability of newly diagnosed elderly adults (including the very old) to adhere to CPAP therapy and the benefit of 5 months' well-conducted CPAP treatment.

REGISTRATION NUMBER

Not applicable.

POS0975 COMPARISON OF CLINICAL AND DEMOGRAPHIC FINDINGS OF PATIENTS DIAGNOSED AS WITH FULL SPINAL FUSION AND WITHOUT ANY SPINE DAMAGE

Background

Erosions and sclerosis are early manifestations of radiographic progression, which can form syndesmophytes that bridge between the vertebrae and eventually lead to spinal fusion or the characteristic bamboo spine appearance in some patients.Bridging syndesmophytes in the spinal column plays a key role in the progression of AS.1 The development of ankylosis in the axial skeleton is considered to be the most important long-term outcome parameter for axial pondyloarthritis (axSpA).2

Objectives

In this study, we aimed to evaluate patients with ankylosing spondylitis (AS) diagnosed with grade 4 sacroiliitis followed in our rheumatology clinic, without spinal column involvement and with complete spinal ankylosis (bamboo vertebra), together with their clinical, demographic and laboratory findings.

Methods

A total of 202 patients with unilateral/bilateral grade 4 sacroiliitis, who were registered in the Dokuz Eylul University Hospital data system, diagnosed with AS according to the modified New York criteria, were included in the study. Cervical, dorsal and lumbar radiographs of all patients were evaluated for structural damage, in addition to lateral and anteroposterior aspects, as well as posterior and facet joint involvement. In the study, all radiographs were evaluated twice at separate times.

Results

It was found that 19 (9.5%) patients had no involvement of the spinal column and 19 (9.5%) had spinal fusion appearance. It was determined that patients with spinal fusion were older (p<0.001) and the frequency of male gender was higher (p=0.042) than patients without any spinal involvement.(Table 1) In multivariate analysis; ≥45 years old [OR: 10.5, CI: 95%, 2.8-39.2; (p<0.001)] and male patients [OR: 10.5, CI: 95%, 1.14-96.56; (p=0.042)] was found to have an increased risk for the development of spinal fusion. TNFi retention rates (78.9% vs. 52.6%), TNF switch rates (53.3% vs. 45.5%) and TNF type distributions were similar in both groups (p>0.05).There was no significant difference between the patients with complete spinal fusion and no spinal involvement in terms of right and left hip BASRI scores (p>0.05).

Table 1.

Demographics

Spinal Involvement (-) (n=19)Full Spinal Involvement (+) (n=19)pn (%)n (%)Age<0.001 ≤4517 (89.5)0 (0)AUC (SH.): 0.945 (0.040) >452 (10.5)19 (100)10.5 (2.8-39.2) OOSex (Erkek)12 (63.1)18 (94.7)0.04210.5 (1.14-96.56) OOCRP11 (57.9)12 (63.2)0.999HLA-B2710 (64.3)9 (60.0)0.831Psoriasis1 (5.2)1 (5.3)-Family History4 (21)0 (0)-Alcohol1 (5.2)2 (10.5)-Cigarette7 (36.8)4 (21.1)0.475Dactylitis1 (5.2)0 (0)-Enthesitis0 (0)1 (5.3)-Uveitis3 (15.7)4 (21.1)0.234IBD3 (15.7)0 (0)-HT1 (5.2)7 (36.8)0.044DM1 (5.2)5 (26.3)0.182CHD0 (0)2 (10.5)-Aortic Failure1 (5.2)0 (0)-

Mann-Whitney U Test (Monte Carlo), ROC (Receiver Operating Curve) Analysis (Honley&Mc Nell - Youden index J); AUC:Area under the ROC curve; OR: Odds Ratio; RC: ROC Curve Analyze, IBD: Inflammatory Bowel Disease, HT: Hypertension, DM: Diabetes Mellitus, CHD: Coronary Heart Disease, CRP: C-Reaktif Protein, n:Number, %: Percent

Conclusion

In our study, we reached four important clinical results: (1) Spinal fusion was observed in 9.5% of the patients with bilateral Grade 4 sacroiliitis diagnosed with AS, 9.5% had no spinal involvement and 81% had varying degrees of spinal injury. (2) Anti-TNF treatment responses were similar in patients with spinal fusion and no spinal involvement. (3) Except for being >45 years old and having a male gender, no other factor was found to predict the development of spinal fusion. (4) There was no difference in the degree of hip involvement between patients with complete spinal fusion and no spinal involvement.

References

[1]Siré E Van Der Heijde, D. et al. Modified stoke ankylosing spondylitis spinal score as an outcome measure to assess the impact of treatment on structural progression in ankylosing spondylitis.

[2]Ramiro, S. et al. Spinal radiographic progression in early axial Spondyloarthritis: Five-year results from the DESIR cohort. Arthritis Care Res. (Hoboken).71, 1678–1684 (2019).

Disclosure of Interests

None declared

POS1478-HPR INCREMENTAL SHUTTLE WALK TEST IN ANKYLOSING SPONDYLITIS PATIENTS

Background

Functional exercise capacity might be affected in ankylosing spondylitis (AS) patients due to factors such as pulmonary function impairment, reduced physical activity, peripheral arthritis, fatigue, muscle weakness and systemic inflammation. In addition to laboratory-based exercise tests, field tests are also used to measure functional exercise capacity. The six-minute walk test (6MWT) which is the most frequently used field test, is valid, reliable, and cost-effective. However, the main disadvantage of the 6MWT is that it allows the patient to set the walking speed. The incremental shuttle walk test (ISWT) is a valid field exercise test of functional capacity. The test requires patients to walk at increasing speeds up and down a 10 m course. The walking speed, which increases every minute, is controlled by audio signals. Performance on the test relates strongly to VO2max, the traditional indicator of cardiorespiratory capacity [1]. Although there are studies evaluating functional exercise capacity in AS patients, no study using ISWT has been found.

Objectives

The aim of this study was to investigate the ISWT results and factors associated with this test in patients with AS.

Methods

Fifty AS patients aged between 25-58 years (27 males,23 females,) participated in the study. Age, height, weight, body mass index (BMI) were recorded. Disease-specific indices such as Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI) were used. Sit-up test and push-up test were used to measure muscular endurance. Incremental Shuttle Walk Test (ISWT) was used to assess functional exercise capacity The test was performed in a 10 m course defined by two cones placed 0.5 m from each endpoint. The test was terminated if the patient was unable to maintain the required speed and failed to complete a shuttle in the time allowed for the second time. The total number of shuttles was recorded and distance calculated. Heart rate (HR), blood pressure, perceived dyspnea and leg fatigue (modified Borg Scale) were assessed before and after the test. Age-predicted maximal heart rate (HRmax) was calculated as 220 minus age. Spearman’s correlation coefficients were used to examine the relationship between the ISWT distance and the variables.

Results

The mean incremental shuttle walk distance (ISWD) of the patients was 458.40± 98.63 m (min 290 m-max 710 m). Subjects reached 50% of the predicted ISWD according to the reference equation for healthy people [2]. The maximal heart rates were lower than predicted values anticipated for the patients’ age. At the end of the test, subjects reached 57.97±8.62 % of HRmax. ISWD showed significant correlations (p<0.05) with gender (r = 0.488), height (r = 0.474), BASFI (r = -0.313), BASMI (r = -0.397), sit-up test (r = 0.620), push-up test(r = 0.476). However, no relationship was found between ISWD and age, weight, BMI, BASDAI, dyspnea, fatique. Dyspnea and fatigue were not limiting factors for the test. The most common reason for stopping the test was the inability of the patients to maintain the set pace. ISWD has been reported to be associated with age [2], but in our study, unlike the literature, no relationship was found between ISWD and age in AS patients.

Conclusion

According to the results of our study, we found that the incremetal shuttle walk test distance in AS patients decreased compared to the reference values reported for healthy individuals. ISWT is associated with factors such as gender, height, functionality, spinal mobility and muscular endurance. ISWT may be appropriate for measuring exercise capacity of AS patients, however, more research is needed.

References

[1]Singh S, Morgan M, Hardman A, Rowe C, Bardsley P (1994) Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. European Respiratory Journal 7 (11):2016-2020.

[2]Probst VS, Hernandes NA, Teixeira DC, Felcar JM, Mesquita RB, Gonçalves CG, Hayashi D, Singh S, Pitta F (2012) Reference values for the incremental shuttle walking test. Respiratory medicine 106 (2):243-248

Disclosure of Interests

None declared

AB0420 UNINTENTIONAL MONOTHERAPY IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING TOFACITINIB AND DRUG SURVIVAL RATE OF TOFACITINIB

Background

Combination of MTX with a bDMARDs or tsDMARDs is considered the most effective treatment regimen currently available for patients with RA who have failed to respond to conventional DMARDs. However, approximately 30% of patients receive bDMARDs as monotherapy in daily clinical practice. Studies in the literature do not assess unintentional monotherapy in general. However, it is thought that some patients may switch to monotherapy unintentionally. In other words, some patients who are prescribed combination therapy switch to monotherapy without informing their physicians.

Objectives

To determine the rate of unintentional monotherapy in rheumatoid arthritis (RA) patients receiving tofacitinib and to evaluate tofacitinib survival rate.

Methods

This national, multicentre, retrospective study included patients’ data from the TURKBIO Registry. Data on demographics, clinical characteristics, disease duration and activity, comorbidities, and treatment were analysed.

Results

Data of 231 RA patients (84.8% female, median age, 56 years) were included; 153 were initially prescribed combination therapy and continued to their therapies; 31 were initially prescribed combination therapy but switched to monotherapy of their own will (unintentional monotherapy); 21 were initially prescribed monotherapy and switched to combination therapy; 26 were initially prescribed monotherapy and continued to their therapies. The combination and unintentional monotherapy groups did not differ regarding remission rate assessed by DAS28-CRP (60.5% and 70%, respectively, p=0.328). The rate of comorbidities at the time of data retrieval was significantly higher in the unintentional monotherapy group compared with the combination group (83.3% vs. 60.3%, p=0.031). Presence of comorbidities was a significant factor affecting switching to monotherapy (p=0.039, Odds ratio: 3.29, 95% CI: 1.06-10.18). Drug survival rates of the unintentional monotherapy and combination groups did not differ. The median drug survival duration of tofacitinib was 27+ months with a 1-year and 4-year drug survival rates of 89.6% and 60.2%, respectively, in the unintentional monotherapy group.

Conclusion

Although 13.4% of the study population started monotherapy unintentionally, drug survival rates of the unintentional monotherapy and combination groups were not different. Comorbidity was an important factor affecting transition from combination therapy to monotherapy.

This study was sponsored by Pfizer.

Figure 1.

Disclosure of Interests

Nevsun Inanc: None declared, Kerem Abacar: None declared, mehmet akif ozturk: None declared, Abdurrahman Tufan: None declared, Hazan Karadeniz: None declared, İsmail Sari: None declared, gercek can: None declared, Yesim Erez: None declared, yavuz Pehlivan: None declared, Ediz Dalkiliç: None declared, Tuğba Ocak: None declared, Ayse Cefle: None declared, Ayten Yazici Grant/research support from: Ayten Yazici has received project grant from Roche Pharmaceuticals, Turkey., Abdurrahman Senel: None declared, Servet Akar: None declared, Elif Durak Ediboglu: None declared, Süleyman Serdar Koca: None declared, Rabia Piskin Sagir: None declared, Sema Yilmaz: None declared, Semral Gulcemal: None declared, Özgül Soysal Gündüz: None declared, Canberk Sami Başibüyük Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Serdar Alkan Employee of: employee and shareholder of Pfizer Inc., Istanbul, Turkey., Teoman Yusuf Cesur Employee of: employee of Pfizer Pharmaceuticals, Istanbul, Turkey., Fatos Onen: None declared

AB1271 PREVALENCE OF RHEUMATOLOGIC DISEASES IN PATIENTS PRESENTING WITH UVEITIS

Background

Uveitis may occur in the course of systemic inflammatory rheumatic diseases, or it may be the first clinical presentation of these diseases.

Objectives

To determine the prevalence of systemic inflammatory rheumatic disease in patients whose initial clinical manifestation is non-infectious uveitis.

Methods

Adult patients diagnosed with non-infectious uveitis in Dokuz Eylul University Ophthalmology Department and referred to investigate the etiology of rheumatological disease were included in the study. Demographic and clinical features, laboratory and imaging findings of the patients were examined.

Results

106 patients diagnosed with uveitis (42.4% anterior uveitis, 2.8% intermediate uveitis, 19.8% posterior uveitis, 34.9% panuveitis) were included in the study. 52.8% of the patients were male and the mean age was 40.19±14.82 years. The mean age of uveitis attack was 38.7±15.02 years. 33% of the patients were diagnosed with rheumatologic disease (10 SpA, 17 Behçet’s Disease, two vasculitis, two sarcoidosis, three undifferentiated connective tissue disease, one rheumatoid arthritis). SpA was diagnosed in 20% of patients presenting with anterior uveitis. Behçet’s disease was detected in 27% of patients referred with panuveitis and in 33.3% of patients whose first clinical finding was posterior chamber involvement. Bilateral uveitis was detected in two-thirds of patients with posterior chamber affected, and it tends to recur more (p=0.014).

Conclusion

A rheumatological disease was detected in approximately one-third of the patients presenting with uveitis. Investigation of patients referred for uveitis in terms of systemic rheumatological diseases is very important as it may change the diagnosis and treatment process.

Disclosure of Interests

None declared

AB0769 Treatment outcomes of patients with biological therapy during pregnancy and effect of pregnancy planning on treatment preferance of rheumatologists

Background

Rheumatic diseases occur mostly in adults at reproductive age. In addition to the impact of disease course on fetal and maternal health, safety concerns regarding the effects of biological drugs on the course of pregnancy have come to the fore with the introduction and widespread use of them. Unlike other biological treatments, all tumor necrosis factor (TNF) antagonists can be used during pregnancy.

Objectives

To investigate clinical features, treatment characteristics and pregnancy outcomes of patients with biological treatment and evaluate impact of planning pregnancy on treatment preferance.

Methods

The study was planned between January 2015 and December 2021. Patients who received biological treatment at conception were determined retrospectively. Demographycal data, clinical features, treatment characteristics and pregnancy outcomes were recorded.

Results

15 patients (mean age 37.2±4) were included. Mean age at diagnosis was 25.6±5.4 and age at gestational was 33±3.9. Mean follow-up duration was 96±55 months. Median period of biological therapy was found 37 (1-156) months. Six (40%) patients were diagnosed with Axial Spondyloarthritis, 6 (40%) Psoriatic Arthritis, 1 (6.6%) Rheumatoid arthritis. While 12 (80%) patients had planned (wanted) pregnancies, 10 (66%) patients were evaluated as eligible for pregnancy in terms of rheumatological disease by rheumatologists. 13 (86.6%) patients were in remission/partial remission before pregnancy. 5 (33.3%) patients were using steroid and disease modifying anti-rheumatic drugs (DMARDs) were stopped before conception. 10 (66.6%) patients were receiving certolizumab, 4 (26.7%) patients were receiving adalimumab. It was found that the treatment of the patient who received rituximab was interrupted due to the pregnancy planning. While certolizumab treatment continued in 6 (60%) patients during pregnancy, the treatment of patients receiving adalimumab was discontinued within first trimester. Activation of disease was occurred in 2 patients whose therapy interrupted. Biological treatment was restarted during pregnancy in 3 of 9 patients whose biological treatment was discontinued. No perinatal complication was developed except premature rupture of membranes in one patient. It was observed that all infants were healthy at birth, but baby of the mother who received certolizumab was diagnosed mental retardation in early childhood.

Conclusion

In this study, it was established that the majority of patients using TNF antagonist during pregnancy;

In this study, it was concluded that having a pregnancy plan may be an important factor for rheumatologists to decide type of TNF antagonist, and physicians tend to prefer certolizumab in patients with pregnancy plan.

Table 1.

Baseline clinical and treatment characteristics

Age, years37.2±4Age, at diagnosis25.6±5.4Age, at gestation33±3.9Follow-up duration, months96±55Biologic treatment duration, months37 (1-156)Rheumatologic diseasen (%) -Spondyloarthritis6 (40) -Psoriatic arthritis6 (40) -Rheumatoid arthritis1 (6.6) -Behcet disease1 (6.6) -Systemic lupus eritematosus1 (6.6)Biologic treatmentn (%) -Certolizumab*10 (66.6) -Adalimumab*4 (26.7)Discontinuation of treatment9 (60)Restart3 (33.3)Disease activityRemission/partial remission*13 (86.6)Activation during pregnancy3 (20)*At conception

Disclosure of Interests

None declared

AB1088 COVID-19 VACCINATION OF SPONDYLOARTHRITIS PATIENTS RECEIVING BIOLOGICAL THERAPY: REAL-LIFE DATA

Background

Considering the concerns regarding COVID-19 vaccine safety among patients with rheumatic diseases due to a lack of data, an urgent need for studies evaluating safety profiles of vaccines emerged.

Objectives

Vaccination against the coronavirus disease-2019 (COVID-19) started in March 2021 in the group using biological therapy in our country. In this study, post-vaccine real-life data of patients with spondyloarthritis (SpA) followed up with biological therapy were analyzed.

Methods

Adult patients diagnosed with SpA who were followed up under biological therapy and vaccinated by CoronaVac inactive SARS-CoV-2 orBNT162b2 messenger RNA (mRNA) COVID-19 (Pfizer-BioNTech) vaccine were included in our observational, multicenter, prospective study.

Results

A total of 287 patients (58.2% male; mean age: 47) were included in the study. 202 (%70,4) of patients were being followed up with the diagnosis of AS, 40 (%13,9) of them with PsA, 32 (%11,1) of them with nr-axSpA, 11 (%3,8) of them with enteropathic arthritis, and 2 (%0,7) of them with uSpA. The most common comorbidities were found to be HT (n:65; 22.6%) and DM (n:38; 13.2%). While 221 (77%) of the patients were receiving biological therapy alone, 27 (9.4%) patients were using methotrexate, 25 (8.7%) patients were using sulfasalazine, and 12 (4.2%) patients were using leflunomide. The median duration of biological therapy was 40 weeks (19-75 IQR). The most commonly used treatment was infliximab (26.8%), adalimumab (23.3%) was the second (Table 1).

It was determined that 207 (72.1%) of the patients preferred inactivated virus vaccine, while 80 (27.9%) preferred mRNA vaccine. When the time between the biological treatment and the day of vaccination is examined, detected median time between biological treatment and the first dose of vaccination is 11.5 days (5-19 IQR), between the first dose of vaccination and biological treatment is 14 days (7-21 IQR), between treatment and the second dose of vaccine is 14 days (5-23.5 IQR), and between the second dose of vaccine and the next biological treatment is 12.5 days (7-15 IQR). While 25 (8.7%) of the patients had COVID-19 infection before vaccination, 7 (2.4%) patients were found to have COVID-19 after vaccination (p<0.001). While two of the patients who had COVID-19 infection in the pre-vaccination period required hospitalization, none of the patients who had COVID-19 in the post-vaccination period required hospitalization.

The rate of patients who developed side effects after the first dose of the vaccine was 20.6%. The side effects seen, respectively, were detected as pain-redness at the injection site (16%), fatigue (11.8%), headache (8.4%), muscle-joint pain (7.3%) and fever (5.6%). The rate of patients reporting side effects after the second dose of the vaccine was 17.1%. The incidence of side effects after mRNA vaccine was found to be statistically significant compared to inactivated virus vaccine in terms of both doses (p=0.011, p<0.001). Major side effects such as myocarditis, anaphylaxis-angioedema, myocardial infarction, and thrombosis were not observed in any of the patients included in the study. There was no evidence of disease activation in the median follow-up of 209 days (145-280 IQR) after vaccination.

Conclusion

During the follow-up of the patients during the study, no major vaccine-related side effects, post-vaccine disease activation and the need for treatment change were not detected. In order to more accurately evaluate the efficacy of the vaccination program in the patient population using biologic agents, larger-scale studies including unvaccinated individuals are needed.

References

[1]Sattui SE, Liew JW, Kennedy K, et al. Early experience of COVID-19 vaccination in adults with systemic rheumatic diseases: results from the COVID-19 global rheumatology alliance vaccine survey. RMD Open. 2021;7(3):e001814.

[2]Shenoy P, Ahmed S, Paul A, et al. Inactivated vaccines may not provide adequate protection in immunosuppressed patients with rheumatic diseases. Ann Rheum Dis. 2021. doi:10.1136/annrheumdi s-2021-221496

Disclosure of Interests

None declared

AB0938 A new screening tool for Psoriatic Arthritis in Psoriasis Patients: TurPAS

Background

Psoriatic arthritis (PsA) is a heterogenous disease with different disease manifestations. Several tools have been developed for screening of PsA in patients with psoriasis with variable performances. An optimal screening tool for PsA is still an unmet need.

Objectives

We aimed to develop a new screening tool in Turkish which could detect different domains involved.

Methods

A core group was determined including 11 rheumatologists/10 dermatologist and a systematic literature review on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis` was performed. The review revealed tools named PEST, PASE, EARP, STRIPP, SIPAS, SIPAT, TOPAS-II, GEPARD, PASQ, CONTEST, A novel, short, and simple screening questionnaire. Each item of those tools were included in the Delphi set. After the 3 rounds of Delphi, a new set of screening questionss was developed.

Results

Overall 85 items were inquired, including questions on joint, dactylitis, enthesitis, back, skin-nail domains as well as morning stiffness, function, treatment and others for the first round of Delphi. Seventeen experts (9 dermatologists/ 8 rheumatologists from the core group) and fifteen patients (Female/Male= 9/6) answered the Delphi (mean (SD) age of 39.3 (10.9) participated to the first round. The involvemet types were peripheral (73.4%), axial (40%), entheseal (33.4) and dactylitis was present in 14% of the patients. As a result of this first evaluation, 44 out of 85 questions were selected and carried to second round The distribution of these questions was as follows; joint question n=13, skin and nail involvement n=6, dactylitis n=5, morning stiffness n=5, axial n=3, enthesitis n=2, general questions n=5. These questions were sent to the members through rheumatology and dermatology societies. In total, 85 rheumatology specialists and 48 dermatology specialists answered the questions in the second round. At the second tour, the number of questions was reduced from 44 to 22. The distribution of the questions was as follows; Skin and nail involvement n=5, dactylitis n=3, joint question n=2, axial involvement n=2, morning stiffness n=2, axial involvement and morning stiffness n=2, enthesitis n=1, general questions n=5. A consensus meeting was held to discuss 22 questions determined at the end of the second round within the initial core group. Each question was handled one by one, some of the questions were combined, if necessary, adapted to Turkish. The tool was given its final form. The final version of the questionnaire consists of 6 questions. (Table 1).

Table 1.

The new screening tool

DomainTurkish versionEnglish versionJointEl/ayak parmaklarinizda ya da herhangi bir ekleminizde hiç şişlik veya ağri oldu mu?Have you ever had swelling or pain in your fingers/toes or any of your joints?DactylitisResimde gösterildiği gibi el veya ayak parmağinizda sosis şeklinde şişlik oldu mu?Have you had a sausage-shaped swelling on your fingers or toes as shown in the picture?EnthesitisTopuk ağriniz olur mu?Do you have heel pain?Axial involvement and morning stiffnessBelinizde, sirtinizda veya boynunuzda istirahatle artan, özellikle sabaha karşi kötüleşen veya sabahlari hareketinizi kisitlayan ağriniz olur mu?Do you have pain in your lower back, back, or neck that increases with rest, worsens especially in the morning, or restricts your movement in the morning?Drug useEklem şikayetleriniz için zaman zaman ilaç kullanir misiniz?Do you take medication for your joint complaints from time to time?History of rheumatic diseaseSize daha önce iltihapli romatizma tanisi konuldu mu?Have you ever been diagnosed with a rheumatic disease before?

Conclusion

A new screening tool targeting different domains in Psoriatic disease was developed in Turkish. While cultural differences play an important role in screening, we believe that the first tool developed in Turkish will be helpful in clinical practice and research settings. Further assessments will be done to understand its validity and reliability within a large cohort of psoriatic patients.

Disclosure of Interests

None declared

AB1106 HOW HAS THE COVID-19 PANDEMIC AFFECTED OUR RHEUMATOLOGY PATIENTS USING BIOLOGICAL/TARGETED DMARDS?

Background

Bioinformatics data, which are becoming more detailed day by day, show that male gender, advanced age, smoking, and comorbidities are associated with poor outcome of COVID-19. However, it is well known that the active disease state that may occur as a result of discontinuing the drugs also increases the susceptibility to infection.

Objectives

It was aimed to investigate the effects of the COVID-19 pandemic on the course and treatment of rheumatic disease in patients with inflammatory rheumatic musculoskeletal disease (iRMD) using biological or targeted synthetic DMARDs (b/tsDMARDs).

Methods

The study was carried out in two stages: while investigating the delay of b/tsDMARD treatment in the first 3 months of the pandemic with the fear of infected by SARS-Cov-2 in the first stage, in the second stage, it was investigated whether all patients who decided to continue treatment after interruption in the 12-month period.

Results

A total of 521 patients were included in the study. It was seen that the iRMD diagnosis were listed as SpA (54.3%), RA (25.7%), PsA (8.4%), vasculitis (6.1%), and others (5.4%). The overall 12-month drug retention rate was 92.3%. Concurrent use of hydroxychloroquine (HCQ) (HR=1.49), iv bDMARD use (HR=1.34), and a history of discontinuation of drug in the first 3 months of the pandemic (HR=1.19) were determined as factors that reduced 12-month drug retention rates.

During a total of 12 months, 34 (6.5%) of patients had COVID-19. COVID-19 was severe in 7 patients and 5 of these patients died.The use of GC (HR=3.81) and having a diagnosis of ILD/COPD (HR=4.96) were found to increase the risk of infected by SARS-CoV-2.

Table 1.

Comparison of demographic and clinical characteristics of patients with COVID-19

DemographicsCOVID-19 (-) (n=487)COVID-19 (+) (n=34)PMedian (Min./Max.)Median (Min./Max.)Age48 (18-86)48 (18-82)0.615Disease Duration130 (22-478)144 (48-519)0.573b/ts DMARD Duration45 (12-192)26 (14-170)0.253GC dose, mg4 (1-16)4 (2-16)0.863n (%)n (%)Gender, F259190.909COVID-19 diagnosis and outcomeHospitalization─11 (32.3)─Mortality─5 (14.7)─Active disease (anytime during the pandemic)82 (16.4)9 (26.5)0.246ILD and/or COPD14 (2.9)4 (8.9)0.002n (%)n (%)b/tsDMARD type0.049TNFi382 (78.4)15 (44.1)0.243Tocilizumab19 (3.9)2 (5.9)0.684Abatacept13 (2.7)1 (2.9)0.886Rituximab9 (1.8)6 (17.6)0.001GC83 (17.0)17 (50.1)0.001

Conclusion

The results of this study with a long follow-up period suggest that the retention rates of b/tsDMARD treatment increased with good communication with iRMD patients during the COVID-19 pandemic.

References

[1]Favalli EG, et al. (2020) Arthritis Rheumatol 72:1600–1606.

[2]Landewé RB, et al. Ann Rheum Dis 79:851–858.

Disclosure of Interests

None declared

AB1342 THE EVALUATION OF 18F-PET-CT USE IN RHEUMATOLOGY CLINICAL PRACTICE WITH DEMOGRAPHIC AND CLINICAL FINDINGS

Background

There is an increasing number of studies in the literature on the use of 18 F-FDG-PET/CT in the diagnosis and treatment follow-up of inflammatory rheumatic and musculoskeletal diseases (iRMD) (1). PET/CT do have an important place in the diagnosis of large-vessel vasculitis (LVV), which shows increased involvement in the walls of large vessels (2).

Objectives

In this study, the aim was to evaluate the demographic, clinical, and laboratory characteristics, compatibility of PET/CT with other imaging methods, and the role of PET/CT in treatment follow-up of the patients who underwent PET/CT at the Rheumatology Clinic between 01.01.2010 and 31.12.2020.

Methods

The patients’ age, gender, comorbidities, iRMD types, medications, PET/CT, and ages at the time of iRMD diagnosis were collected. In addition, the compatibility of PET/CT with other imaging methods (MR angiography, Doppler US, and CT angiography) was evaluated in vasculitis subgroups. Control PET/CT images of the patients were evaluated by comparing them with previous imaging findings.

Results

A total of 280 patients, 179 (63.9%) women, with a mean age of 58±15 years, underwent PET/CT in the rheumatology department. 202 (72.1%) patients had a diagnosis of iRMD before PET/CT. After PET/CT, 40 (48.2%) patients were diagnosed with a new iRMD, and 43 (41.8%) were diagnosed with a non-iRMD. No rheumatic disease was detected in 33 (11.8%) patients.

iRMD diagnosed by PET/CT are respectively; LVV (n=11), IgG4-RD (n=10), sarcoidosis (n=9), and other (n=10). It was determined that 22 (26.5%) of newly diagnosed patients other than iRMD had malignancy [Bronchial (n=8), lymphoma (n=3), breast (n=3), other (n=8) cancer].

PET/CT revealed lymphadenopathy (LAP) in 119 of 165 patients who underwent the scan to exclude malignancy, and 22 of 91 patients who underwent PET/CT for rheumatologic diagnosis. LAP was found in 45% of those diagnosed with iRMD and 74.4% of those diagnosed with non-iRMD (p=0.002).

PET/CT imaging was performed on 18 patients for follow-up. The treatment of 4 out of 18 patients with follow-up PET/CT and 76 out of 280 total patients was changed after imaging. In patients with a diagnosis of giant cell arteritis (GCA), the compatibility of PET/CT with MRA was 62.5%, while its agreement with CTA was 100%, and with Doppler US was 40%. In patients diagnosed with Takayasu’s arteritis, the compatibility of PET/CT with MRA was 40%, while its compatibility with CTA was 50% and with Doppler USG was 38%.

Conclusion

PET/CT imaging was found to be an important adjunctive examination in the diagnosis and follow-up of sarcoidosis, LVV, and IgG4-RD in patients evaluated in the rheumatology clinic. It has been observed that it is often used in the diagnosis and follow-up of RA, SpA, and autoinflammatory diseases, to investigate the malignancies accompanying rheumatic diseases and to evaluate the characteristics of LAP. PET/CT findings provide significant benefits to the clinician in the early diagnosis of iRMDs and differentiation of malignant and/or infectious etiologies.

References

[1]Jamar F, et al. EANM/SNMMI Guideline for 18 F-FDG Use in Inflammation and Infection. J Nucl Med. 2013 Apr;54(4):647–58.

[2]Schönau V, et al. Ann Rheum Dis. 2018 Jan;77(1):70–7.

Table 1.DemographicsAge (mean±SD.)58±15Female/Male179 (63.9)/101 (36.1)CRP (mg/L), median (Min.-Max.)16.9 (0.2-431)ESR (mm/h), median (Min.-Max.)43 (1-120)iRMD Subgroups, n (%)Connective Tissue Disease70 (28.4)Vasculitis63 (25.5)Rheumatoid Arthritis28 (11.3)İgG4-RD and Retroperitoneal Fibrosis22 (8.9)Spondyloarthropathies21 (8.5)Sarcoidosis16 (6.5)Polymyalgia Rheumatica8 (3.2)Others (Autoinflammatory Fever Syndromes, Crystal Arthropathies, CVID)19 (7.7)Reason for PET/CT scan, n (%)For Rheumatologic Diagnosis91 (32.5)Scan to Exclude Malignancy165 (58.9)Treatment Response Evaluation24 (8.6)PET/CT SUVmaxValuesiRMD SUVmax, median (Min.-Max.)4.6 (3.3-7.2)Malignancy SUVmax, median (Min.-Max.)8 (6.1-10.6)

*iRMD: inflammatory rheumatic and musculoskeletal diseases

Disclosure of Interests

None declared

AB1295 TREATMENT OUTCOMES OF ADULT-ONSET STILL’S DISEASE PATIENTS WITH BIOLOGICAL THERAPY

Background

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder with heterogeneous distrubition (1). Due to rarity of AOSD and limited controlled study about efficacy of biologic treatment in AOSD, management of refractory AOSD patients poses several challenges.

Objectives

The aim of this study to investigate clinical characteristics and treatment outcomes of AOSD patients who receive biological therapy.

Methods

Patients were identified who met Yamaguchi classification criteria between January 2010 and December 2021 from our database. AOSD patients treated with biologic treatment were included in this study. Demographic data, clinical features and treatment characteristics were recorded.

Results

49 AOSD patients were identified from database. 9 AOSD patients with biologic therapy (7 female, mean age 42.3±19) were included in this study. Mean age at diagnosis was 31.5± 16.7 and mean follow-up period was 9.3± 5.5 years. Median drug retention duration was found 95 (5-150) months. It was established that all patients used high dose steroid at diagnosis and 3 (33.3%) out of them received pulse steroid therapy. Initial therapy was methotrexate for all patients and leflunomid was used secondly as monotherapy or combination therapy after methotrexate inefficacy. It was observed that indication for biologic therapy was arthritis and systemic inflammatuar symptoms in 5 patients. 4 patients was initiated biologic therapy for refractory arthritis without systemic inflammation findings. First biologic agents were tocilizumab and etanercept in 3 patients, infliximab and anakinra in 2 patients. It was shown that biological therapy was switched in 3 patients due to inefficacy and 2 patients because of side effects. Allergic reaction developed in 2 patients treated with infliximab and infliximab switched to adalimumab and etanercept. Biological therapy was discontinued in 2 patients due to remission, and patients remained in remission after cessation of biological agent. None of patients had serious infection. Hemophagocytic syndrome was developed in only one patient during disease course.

Conclusion

According to our cohort, one of five AOSD patients received biological therapy during follow-up. Our results revealed that the need for biologic therapy during the course of the disease is not uncommon in AOSD, and that biologic therapy is essential for maintaining remission in resistant patients.

References

[1]Efthimiou P, Georgy S. Pathogenesis and management of adult-onset Still’s disease. Semin Arthritis Rheum. 2006 Dec;36(3):144-52. doi: 10.1016/j.semarthrit.2006.07.001. Epub 2006 Sep 1. PMID: 16949136.

Table 1.

Baseline clinical and treatment characteristics (n=9)

Female, n (%)7 (77.7)Age, years42.3±19Age at diagnosis, years31.5± 16.7Smokers, n (%)6 (66.6)Drug retantion duration, months95 (5-150)Follow-up time, years9.3± 5.5Treatment characteristicn (%)Biologic therapy indication -Systemic inflammation findings5 (55.5) -Refractory arthritis4 (44.4)İnitial biologic therapy Etanercept3 (33.3) Tocilizumab3 (33.3) Infliximab2 (22.2) Anakinra2 (22.2)Switching agent5 (55.5)Cessation of biologic therapy3 (33.3)

Disclosure of Interests

None declared

OP0047 IMPAIRED JAK-STAT PATHWAY IN PATIENTS WITH PYODERMA GANGRENOSUM

Background

Pyoderma gangrenosum (PG) is an inflammatory disease with an unknown etiology. Currently there is an unmet need in the of PG. In recent years, JAK/STAT pathway have been shown to have an important role in the etiology of inflammatory conditions particularly in the field of dermato-rheumatology. However, current data on JAK/STAT pathway in PG is significantly limited.

Objectives

Herein we aimed to investigate the JAK/STAT signaling pathway in the skin biopsies of PG patients and compared with psoriasis (PSO) and healthy subjects (HS).

Methods

31 patients with PG, 35 patients with PSO and 26 HS were included. Immunohistochemical methods were used to evaluate the expression of JAK1, JAK2, JAK3, Tyrosine Kinase 2 (TYK2), STAT1, STAT3, STAT4, STAT5, and STAT6. In the dermis the staining intensity was recorded as ‘positive’ or ‘negative. The epidermal part is divided into cytoplasmatic and nuclear parts and staining intensity recorded by semi-quantitively as follows: negative, mildly positive, moderately positive and strongly positive.

Results

In total, there were 92 biopsies. Dermal staining was significant for all the JAK/STAT proteins for patients with PG and PSO when compared to HS. On the other hand, there were no differences in the staining patterns of PG and PSO. For the investigation of cytoplasmic parts of epidermis JAK1, STAT3, and STAT4 were highly expressed in the PG and PSO, STAT6, and TYK2 were only significantly overexpressed in psoriasis. JAK3 was overexpressed in healthy skin, PG and psoriasis. The assessment of the nuclear part of epidermis TYK2 and STAT3 were highly expressed in the PG and PSO. JAK1 was overexpressed in PG versus PSO in cytoplasmic parts of the epidermis (p<0.001). TYK2 and STAT6 were highly expressed in the PSO versus PG in cytoplasmic parts of the epidermis (p = 0.024, p<0.001). In the investigation of nuclear parts of epidermis STAT1, STAT6 were highly expressed in the PSO versus PG. The summary of the findings is given in Table 1.

Table 1.

Summary of the findings

Healthy Subjects (n=26)Pyoderma Gangrenosum (n=31)Psoriasis (n=35)Age, mean ± SD60,3 ± 18,358,1 ± 16,146,5 ± 18,4Women/men (%)14/1218/1315/20Dermal stainingJAK1Positive, n (%)07 (22.6)*3 (8.5)JAK3Positive, n (%)027 (87)*31 (88.5)**TYK2Positive, n (%)031 (100)*34 (97.2)**STAT1Positive, n (%)020 (64.5)*27 (77.1)**STAT3Positive, n (%)029 (93.6)*1 (2.8)STAT4Positive, n (%)07 (22.6)*11 (31.4)**STAT5Positive, n (%)09 (29.3)27 (77.1)**STAT6Positive, n (%)03 (9.7)33 (94.3)**cytoplasmic parts of epidermisJAK1Negative, n (%)010Mildly positive, n (%)000Moderately positive, n (%)23 (88.4)6 (19.4)24 (68.5)Strongly positive, n (%)3 (11.5)24 (77.4)*11 (31.5)**TYK2Negative, n (%)0 (0)1 (3.2)2 (5.7)Mildly positive, n (%)0 (0)4 (12.9)1 (2.8)Moderately positive, n (%)18 (69.2)18 (58.1)11 (31.4)Strongly positive, n (%)8 (30.8)8 (25.8)21 (60)**STAT3Negative, n (%)01 (3.2)0Mildly positive, n (%)01 (3.2)0Moderately positive, n (%)12 (46.1)1 (3.2)1 (2.8)Strongly positive, n (%)14 (53.9)28 (90.4)*34 (97.2)**STAT4Negative, n (%)01 (3.2)0Mildly positive, n (%)01 (3.2)0Moderately positive, n (%)12 (46.1)3 (9.7)6 (17.1)Strongly positive, n (%)14 (53.9)26 (83.9) *29 (82.9) **STAT6Negative, n (%)18 (69,2%)15 (48,4%)1 (2,8%)Mildly positive, n (%)8 (30,8%)16 (51,6%)0Moderately positive, n (%)0020 (57,2%)Strongly positive, n (%)0014 (40%)**nuclear part of epidermisTYK2Negative, n (%)22 (84,6%)1 (3,2%)2 (5,7%)Mildly positive, n (%)4 (15,4%)10 (32.2%)6 (17,1%)Strongly positive, n (%)020 (64,6%)*27 (77,2%)**STAT3Negative, n (%)01 (3,2%)0Mildly positive, n (%)16 (61,5%)2 (6,5%)5 (14,3%)Strongly positive, n (%)10 (38,5%)28 (90,4%)*30 (85,7%)**

Data were shown mean±SD and n (%), *= significant expression HS vs PG, **= significant expression HS vs PSO.

Conclusion

In this study, the JAK/STAT inflammatory pathway is significantly activated in PG patients which is adding up new information to the current literature. Considering the unmet need in PG targeting of this pathway could be beneficial for the treatment of refractory PG.

Disclosure of Interests

None declared.

AB1103 THE EFFECT OF COVID-19 PANDEMIC IN A LARGE SERIES OF PATIENTS WITH TAKAYASU ARTERITIS

Background

Patients with inflammatory rheumatic diseases faced several challenges during the COVID-19 pandemic. Uncertainties such as the lack of evidence regarding the use of immunosuppressive (IS) therapies and deferred patient care because of limited health resources impacted negatively on many aspects of treatment decisions and routine follow-up of the patients (1).

Objectives

We aimed to investigate the prevalence and severity of SARS-CoV-2 infection, the impact of the pandemic on delays in routine clinical follow-up, changes in IS treatment, and COVID-19 vaccination status of patients with Takayasu arteritis (TAK).

Methods

The study was performed between July and September 2021. TAK patients who registered in our database were investigated with regards to the COVID-19 infection and vaccination status, delays in routine clinical visits, changes in their IS treatments, and flares during the pandemic. Physical examination, laboratory tests, and imaging of the patients were performed and ITAS2010 scores were calculated.

Results

There were 56 adult TAK patients (87.5% female and median age 47 years). 44 (78.6%) patients experienced a delay with routine follow-up visits to their physicians and about 20% of patients stopped their antirheumatic treatments without consulting their physicians. Compared to the pre-COVID-19 pandemic, 16 (28.5%) patients were flared. 13 (23.2%) patients had a mild COVID-19 infection. Pneumonia was reported in five patients, two of them required hospitalization, and all patients recovered completely. In the total group, about 90% of the patients had received the COVID-19 vaccine (Table 1).

Table 1.

Effects of COVID-19 pandemic on patients with Takayasu arteritis

Patients with a delay regarding to the routine follow-up visits, n (%)44 (78.6)Average delay in routine follow-up visits since the beginning of COVID-19 pandemic (months), median, Q1-Q33.5 (2.25-9)Patients who don’t receive their treatment regularly due to COVID-19 concern, n (%)11 (19.6)Disease relapse compared to the pre-pandemic time, n (%)16 (28.6)Progression in acute phase reactants, n (%)14 (25)Progression in vascular involvement (according to MR angiography or Doppler ultrasound findings) n (%)15 (26.8)Patients diagnosed with COVID-19 disease, n (%), pre-vaccination / post-vaccination13 (23.2), 8/5Vaccination status, n (%)50 (90.9)

Continuous data is presented with median (interquartile range, Q1-Q3) values and categorical data are presented as counts (n) and percentages (%)

Conclusion

COVID-19 disease in TAK patients were in mild severity and IS therapy seem not affecting the COVID-19 course. A substantial number of patients who stopped their medications flared and its long-term consequences need to be assessed by large-scale studies. New approaches are required to maximize healthcare access for patients who have chronic diseases during pandemic.

References

[1]Sanchez-Piedra C, Diaz-Torne C, Manero J, Pego-Reigosa JM, Rúa-Figueroa Í, et al. Clinical features and outcomes of COVID-19 in patients with rheumatic diseases treated with biological and synthetic targeted therapies. Annals of the Rheumatic Disease. 2020; 79(7): 988-990. doi: 10.1136/annrheumdis-2020-217948.

Disclosure of Interests

None declared

AB1312 HIGH PREVALENCE OF iRMD IN SARCOIDOSIS PATIENTS

Background

Sarcoidosis is a chronic granulomatous disease that primarily affects the lungs and lymph nodes, and can affect any organ and system (1). The incidence of concomitant iRMD is increased in patients with sarcoidosis. Anti-nuclear antibody (ANA) test are frequently used markers for inflammatory rheumatic diseases (iRMDs) (2). The relationship of this association with ANA is not clear.

Objectives

We aimed to determine the frequency of ANA in sarcoidosis patients and its possible correlation with clinical and laboratory data, and also to reveal the severity of osteoporosis in patients with sarcoidosis.

Methods

Ninety sarcoidosis patients, who were followed up in rheumatology clinic were included in this study. ANA were determined with indirect immunofluorescent method and 1/160 titration was accepted as positive. Demographic, clinical, serological, and bone mineral densitometry (BMD) results of all patients were recorded. BMD results were obtained from the images taken before the last date or osteoporotic fracture of the patients.

Results

Average age of the 90 patients (79 females) with sarcoidosis was 57.5 (IQR: 51–66) years, and median disease duration was 7.6 (IQR: 4-19) years. 28 (31.1%) patients had a diagnosis of extrapulmonary sarcoidosis (Most commonly skin, n=20, 71.4%). 21 patients had BMD values consistent with osteoporosis, while 9 patients had osteoporotic fractures. In 18 (20%) patients, rheumatologic autoimmune disease combined with sarcoidosis was found. SpA was diagnosed in 6 patients, RA in 2 patients, Lofgren Syndrome in 2 patients, SjS in 2 patients, systemic sclerosis in 1 patient, and morphea in 1 patient. Other rheumatological diseases were found as uBDH, polymyositis, Gout, Behçet’s Disease and FMF. ANA test was performed in a total of 83 patients. ANA positivity was found in 30 (36.1%) patients with sarcoidosis (1/100-1/320 in 12 patients; >1/320 in 18 patients). There was no significant relationship between ANA positivity and gender distribution, age, disease duration, development of extrapulmonary sarcoidosis, refractory disease status, and laboratory findings at the time of diagnosis. It was found that ANA positivity at diagnosis time for sarcoidosis increased the risk of developing iRMD 4.8 times in patients [HR: 4.8, CI 95% (1.455-15.833), p=0.009].

Conclusion

In sarcoidosis, ANA positivity is of great importance in the determination of accompanying iRMDs. It was found that ANA positivity at the time of diagnosis in sarcoidosis patients increased the risk of developing rheumatological autoimmune disease 4.8 fold. Since these patients receive long-term moderate-high-dose steroid-based treatments, they should be closely monitored and screened for osteoporosis.

References

[1]Wessendorf TE, et al. Clin Rev Allergy Immunol. 2015 Aug 18;49(1):54–62.

[2]Kobak S, et al. Autoimmune Dis. 2014;2014:1–4.

Table 1.

Distribution of clinical features of patients with sarcoidosis according to ANA results

ANA (-) (n=53)ANA (+) (n=30)n (%)n (%)p valueGenderFemale46 (86.8)27 (90)>0.05Male7 (13.2)3 (10)Rheumatic DiseaseNo48 (90.6)20 (66.7)0.009 (HR: 4.8, CI 95% (1.455-15.833)*Yes5 (9.4)10 (33.3)Refractory DiseaseNo35 (66)19 (63.3)Yes18 (34)11 (9.1)BMD-DEXANormal16 (43.2)12 (60)0.630Osteopenia14 (37.8)4 (20)Osteoporosis7 (18.9)4 (20)Osteoporotic FractureNo46 (86.8)28 (93.3)0.477Yes7 (13.2)2 (6.7)Median (IQR)Median (IQR)p valueAge (year)56.5 (51/64)58 (51/66)0.836Follow-up duration (year)6 (4/10)6 (2/9)0.718Age at diagnosis (year)45.5 (38/55)49 (36/55)0.861Calcium (mg/dL)9.585 (9.25/9.9)9.4 (9.17/9.76)0.13825 (OH)D (pg/ml)15.5 (10.1/24)8 (6/12)0.005Phosphorus (mg/dL)3.65 (3.245/3.98)3.75 (3.3/4.1)0.17ACE (mcg/L)60 (32/87)59.595 (34/88.225)0.876ESR (mm/h)23 (15/39)29 (22/48)0.171CRP (mg/dL)4.8 (2.3/17)5.4 (2.7/24)0.343

*Multivariate regression analysis

Disclosure of Interests

None declared

AB0762 Incidence Of Anterior Uveitis In Axial Spondyloarthritis During Secukinumab Treatment: TWO YEARS REAL LIFE EXPERIENCE FROM TURKBIO REGISTRY

Background

Secukinumab (SEC), a human anti-IL-17A monoclonal antibody, has similar treatment response rates to tumor necrosis factor (TNF) inhibitors in patients with axial spondyloarthritis (SpA). However, the efficacy of SEC on anterior uveitis (AU) is unclear.

Objectives

This study aimed to evaluate the risk of new-onset or relapsing AU in axial SpA patients treated with SEC.

Methods

In this prospective cohort study, 130 axial SpA patients receiving SEC at the TURKBIO registry between 2019 and 2021 were evaluated. Demographic and clinical characteristics and data about the presence of AU pre or post-treatment were collected. The univariate and multivariate logistic regression analyses were performed to evaluate the predictors of AU development.

Results

The mean age of the patients (F/M: 59/71) was 47.4±10.9 years. The median follow-up time was 540 days (IQR: 330-630). SEC was the first biological agent in 50 (38.4%) patients and 35 (26.9%) patients were using at least one concomitant conventional synthetic DMARD (Table 1). While continued SEC therapy was in 93 (71.5%) patients, treatment withdrawal was in 37 cases (in 26 due to ineffectiveness, two adverse events and nine other reasons). Overall, 15(11.5%) patients had a history of AU before the SEC. During follow-up, AU attacks were seen in the 6 cases (4 were new-onset and 2 were flare) and 5 of these patients have a history of inadequate response to TNF inhibitors. The frequency of AU was calculated as 3.42 per 100 patient-years during SEC treatment. The only significant predictor of AU development was the baseline high C-reactive protein (CRP) level on multivariate analysis (p=0.003, OR: 1.063 [95% CI 1.021-1.107]).

Table 1.

Demographics and clinical characteristics of the patients

Total (n:191)Gender (F/M)59/71Age (years) (mean±SD)47.4±10.9Diagnosis; n (%)   AS125 (96.2)   nr-axSpA5 (3.8)BASDAI (mean±SD)47.2±20.48   Missing n (%)4 (3.07)ASDAS (mean±SD)3.32±0.92   Missing n (%)14 (10.7)C-reactive protein (mg/L) median (IQR)12.6 (4.67-22.62)Sedimentation (mm/h) median (IQR)22 (9-42)Concomitant csDMARDs n (%)35 (26.9)Secukinumab dose n (%)   150 mg120 (92.3)   300 mg10 (7.7)TNFi-naive patients n (%)50 (38.5)Number of previous bDMARDs n (%)   136 (27.7)   223 (17.7)   ≥ 321 (16.1)History of previous TNFi n (%)   Monoclonal TNFi64   Etanercept16

AS; Ankylosing spondylitis, nr-axSpA; Non radiographic axial spondyloarthritis, BASDAI; Bath Ankylosing Spondylitis Disease Activity Index, ASDAS; Ankylosing Spondylitis Disease Activity Score, csDMARD; conventional synthetic disease modifying anti-rheumatic drug, TNFi; Tumor necrosis factor inhibitors, bDMARD; biological DMARD. Datas were expressed as number (%), mean±SD or median (IQR).

Conclusion

In this real-life data from the TURKBIO registry, the incidence of AU in axial SpA patients treated with SEC was calculated as 3.42 per 100 patient-years. A high baseline CRP level was an independent factor for developing AU.

Disclosure of Interests

None declared

AB1424 INVESTIGATION OF THE TYPE AND FREQUENCY OF NEUROLOGICAL SIDE EFFECTS WITH BIOLOGICAL TREATMENT IN INFLAMMATORY RHEUMATIC DISEASES

Background

With the increasing use of biological treatment in inflammatory rheumatic diseases, some neurological side effects, especially central and peripheral nervous system demyelinating disorders, are seen.

Objectives

To evaluate whether there is an increase in the frequency of neurological disorders with biological treatment compared to the normal population, and the relationship between discontinuation of biological agents and neurological symptoms.

Methods

Adult patients using biological treatment followed in the Rheumatology outpatient clinic of Dokuz Eylul University between January 2011 and January 2020 were included. The relationship between biological agents and type, severity and duration of neurological symptoms, and the laboratory, imaging (cranial CT, MRI) and electrophysiological findings of the patients were retrospectively reviewed. Current treatments for rheumatologic disease and neurological findings, and disease activity were investigated.

Results

In our study, neurological side effects were observed in 16 (1.8%) of 877 patients using biological drugs. The mean age of the patients was 51.8±12.53 years, and the duration of rheumatologic disease was 10.69±4.86 years. Nine patients had peripheral neuropathy, two had CNS demyelinating disease, two had peripheral demyelinating disease, two had intracranial mass and one had headache syndrome. The neurological disease developed a mean of 51.31±44.26 months after the first biological agents. The demographic and clinical characteristics of the patients and the neurological side effects that developed during the follow-up period are summarized in Table 1. Biological treatment was discontinued in 68.8% of patients. There was no significant correlation between biological agents’ continuation status and progression of neurological findings.

Table 1.

Demographic and clinical characteristics of patients who developed neurological symptoms with biological treatment

n=16 (%)GenderMale8 (50)Age of diagnosis (years)¶41,13±12,02Disease duration (years)¶10,7±4,86Smokingactive7 (43,8)exmoker2 (12,5)CRP (mg/L)¶5,03±6,28bDMARDAdalimumab5 (31,3)İnfliximab4 (25,0)Etanercept2 (12,5)Certolizumab1 (6,3)Tocilizumab1 (6,3)Secukinumab2 (12,5)Tofacitinib1 (6,3)Imaging (CT, MRI)Presence of pathological findings5 (31,3)Electrophysiological studyPresence of pathological findings8 (50,0)Neurological Side EffectDiabetic Amyotrophy1 (6,3)Foot drop1 (6,3)Grade 2 astrocytoma1 (6,3)Meningioma1 (6,3)Cauda equina syndrome1 (6,3)Cubital Tunnel Syndrome1 (6,3)Multiple sclerosis (de nova)1 (6,3)Multiple sclerosis attack1 (6,3)Myasthenia gravis attack1 (6,3)Radicular neuropathy1(6,3)Sensorimotor polyneuropathy1 (6,3)Sensory neuropathy1 (6,3)Pseudotumor cerebri worsening1(6,3)Facial paralysis1 (6,3)CIDP progression1(6,3)Guillain Barre Syndrome1 (6,3)Time to development of adverse events after last bDMARD¶26,37±29,58Time after neurological adverse event (months)¶23,75±20,86bDMARD continuation status after adverse eventsbDMARD discontinuation11 (68,8)Neurological symptoms at last visitStable6 (37,5)Improvement9 (56,3)Progression1(6,3)

¶ mean±SD

. CIDP:Chronic inflammatory demyelinating polyneuropathy

Conclusion

In this study, the prevalence of neurological diseases such as brain tumors, multiple sclerosis, and myasthenia gravis increased in patients receiving biological treatment compared to the normal population. Therefore, patients using biological agents should also be questioned and examined in terms of neurological symptoms, and further examination should be applied if necessary. No significant relationship was found between discontinuation of biological drugs and improvement/progression of neurological symptoms, and more comprehensive studies are needed.

Disclosure of Interests

None declared

The prevalence of non-vascular pulmonary manifestations in Takayasu's Arteritis patients: A Retrospective multi-centred Turkish cohort study

Objectives Takayasu's arteritis (TAK) is a rare vasculitis characterized by inflammation of intermediate- to large-size arteries. Although pulmonary artery involvement (PAI) is an expected finding in some TAK patients, data on non-vascular pulmonary involvement (NVPI) are limited. We aimed to investigate the frequency of NVPI, including parenchymal infiltration, nodules/cavities, pleural effusion, and haemorrhage, in TAK.Method We assembled a retrospective cohort of TAK patients from nine tertiary centres in Turkey. The demographics and clinical characteristics of patients were extracted from medical records and the imaging findings were evaluated for pulmonary manifestations.Results As of January 2021, 319 TAK patients (female/male 276/43; mean age 42.4 ± 13.5 years) were recruited. Eighty-two patients had cough and/or dyspnoea and four had haemoptysis as pulmonary symptoms. On computed tomography assessment, the overall frequency of NVPI was 7.2%; parenchymal infiltrations were present in 10 (3.1%), pleural effusion in eight (2.5%), nodules/cavities in six (1.9%), and pulmonary haemorrhage in four patients (1.3%). In the whole cohort, 10.3% of patients had pulmonary artery hypertension (PAH) and 5.6% had PAI. Among patients with PAH or PAI, the overall frequency of NVPI was significantly higher than in the rest of the group.Conclusions In this TAK cohort from Turkey, we observed NVPI in 7.2% of patients, with parenchymal infiltrations being the most common, followed by pleural effusion. Notably, NVPI was more frequent in patients with PAH or PAI. Although not as common as PAI, NVPI should be kept in mind, especially in TAK patients with PAH or PAI.

Observation and Interview-based Diurnal Sleepiness Inventory for measurement of sleepiness in patients referred for narcolepsy or idiopathic hypersomnia

STUDY OBJECTIVES

First, to determine whether the 3-item Observation and Interview-based Diurnal Sleepiness Inventory (ODSI) measures the degree of excessive daytime sleepiness in patients with suspected narcolepsy or idiopathic hypersomnia (IH). Second, to assess the correlation between the ODSI and the Epworth Sleepiness Scale (ESS) as well as objective polysomnographic measurements. Third, to test the accuracy of the ODSI to detect narcolepsy or IH (narcolepsy/IH) compared with the ESS.

METHODS

A total of 181 patients complaining of excessive daytime sleepiness filled in the ESS and the ODSI and underwent measurements including actigraphy, full-night polysomnography, Multiple Sleep Latency Test, and 24-hour bedrest sleep recording.

RESULTS

Narcolepsy or IH was diagnosed in 76 patients. The ODSI found excessive daytime sleepiness in 92.3% of all patients and in 98.7% of those diagnosed with narcolepsy/IH. In the whole population, the ODSI was significantly positively correlated with the ESS (R = .547; 95% confidence interval: .436, .642; P < .001) and weakly with 24-hour total sleep time on bedrest recording (R = .208; 95% confidence interval: .056, .350; P = .047) but not with the Multiple Sleep Latency Test. The ODSI offered a higher negative (92.9%) and positive (44.9%) predictive value to detect narcolepsy/IH than did the ESS (66.7% and 43.3%, respectively). In the IH group, the ODSI's third-item score (daily sleepiness duration) was significantly higher in patients with than without increased 24-hour total sleep time (P = .023).

CONCLUSIONS

The ODSI is a brief, simple first-line questionnaire that explores both intensity and duration of daytime sleepiness and offers a high sensitivity to detect narcolepsy and IH.

POS0750 THE CHARACTERISTICS OF SYSTEMIC LUPUS ERYTHEMATOSUS WHO HAVE CONSTITUTIONAL SYMPTOMS AND LYMPHADENOPATHY

Background:

Systemic lupus erythematosus (SLE) is the prototype of systemic autoimmune diseases. It may affect any organ system and may present with a variety of clinical symptoms. Lymphadenopathy (LAP) is a nonspecific finding of SLE and often associated to the active disease state. LAP associated SLE pose a significant diagnostic challenge especially in the presence of constitutional symptoms.

Objectives:

In this retrospective cohort study, we evaluated the clinical and imaging characteristics of SLE patients who presented with LAP and constitutional symptoms.

Methods:

SLE Patients with lymphadenopathy who had constitutional symptoms were reviewed retrospectively. The characteristics of the patients such as age, sex, disease duration, clinical features, and laboratory tests including autoantibodies against ANA, dsDNA and ENA were recorded. Imaging findings such as positron emission tomography–computed tomography (PET/CT), thoracal or abdominal CT or diagnostic lymph node biopsy were identified.

Results:

There were 28 patients in this study. The mean age at the time of LAP was 38.9±15.2 years, 22 (78.6%) were female. All patients were fulfilling SLICC 2012 classification criteria for SLE. LAP was the presenting feature of SLE in 15 (53.6%) patients. The most common clinical features associated with LAP were arthritis (42.8%), fever (35.7%), acute lupus rash (32.1%) and serositis (28.5%). There were 11 (39.2%) who had significant proteinuria and 4 (14.3%) had class III or IV renal histology. Anti-phospholipid antibodies were present in nearly one-third of the patients and 12 of them had venous or arterial thrombosis or pregnancy co-morbidity. Cervical LAP was present in 57.1%, axillary LAP in 82.1% and inguinal in 36%. On CT, the prevalence of thoracal and abdominal LAP and hepatomegaly and splenomegaly were 61.5%, 37,5%, 40% and 16% respectively. The pericardial and pleural effusion and intra-abdominal free fluid were 19.2%, 30.8% and 10.2% respectively. There were 19 (67.8%) patients who underwent PET/CT imaging and all were reported as reactive LAP. In terms of SUV max 7 (36.8%) of them had a threshold ≥2.5. 17 (60.7%) patients required lymph node biopsy; 2 did not include lymphoid tissue, 4 (30.7%) with atypical lymphoid hyperplasia suggestive of viral infection and remaining were reactive lymphoid hyperplasia. Autoantibody testing showed that anti-dsDNA was positive in 66.7% and the most common anti-ENAs were anti-nucleosome (35.7%) and anti-Sm-RNP (35.7%) followed by anti-SSA (25%), anti-ribosomal P (17.9%) and anti-histone (14%). The clinical and laboratory features of the clinical and laboratory features of the group is summarized in Table 1.

Table 1.

Data at the time of LAP

Age, years38.9±15.2Disease duration, months3 (2- 300)SLE-DAI, median (min-max)9 (2-30)Sex, female n(%)22 (78.6)Clinical featuresn (%)Acute cutaneous9 (32.1)Arthritis12 (42.8)Fever10 (35.7)Other constitutional symptoms18 (64.2)Serositis8 (28.5)Renal involvement11 (39.2)Neurologic involvement1 (3.6)Leucopenia7 (25.0)Trombositopenia5 (17.8)Hemolitic anemia7 (25.0)ANA (+)>1/32028 (100)Anti-dsDNA (+)18 (66.7)Anti-Sm(+)5 (17.9)Anti-phospholipid antibody (+)9 (32.1)Low complement16 (88.5)

Conclusion:

We showed that SLE patients who had constitutional findings and LAP could be the presenting feature and may confer a significant diagnostic challenge in which the patients might require invasive procedures and advanced imaging modalities. PET/CT revealed reactive changes in lymph nodes in all patients but lymph node biopsy revealed atypical changes in some patients suggestive of viral infections. On the other hand, LAP patients with constitutional symptoms represents a severe phonotype of the SLE as there were significant renal and thrombotic disease.

Disclosure of Interests:

None declared

AB0459 ARTICULAR INVOLVEMENT IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

SSc (systemic sclerosis) is a connective tissue disease characterized by small vessel vasculopathy, production of autoantibodies, and fibroblast dysfunction leading to increased deposition of extracellular matrix in the skin and internal organs mainly. Therewithal, many SSc patients develop musculoskeletal symptoms during the course of their illness. Different rheumatic complaints such as arthralgia, arthritis, contractures, tendon friction rubs, calcinosis, and acroosteolysis can be seen as musculoskeletal symptoms in SSc patients [1].

Objectives:

To provide an overview of the spectrum of articular involvement in SSc and determine the relationship between these involvements and Rheumatoid factor (RF) and Anti-cyclic citrullinated peptide (Anti-CCP) positivity and organ involvements.

Methods:

We performed a retrospective cohort study involving 232 SSc patients who were followed up in our department of rheumatology between 2000 and 2020 years. The patients were divided into two groups as limited and diffuse SSc. Age, gender, weight, height, smoking habits, duration of illness, follow-up duration, other systemic organ involvement, and radiographic findings were recorded. Diagnostic tests such as RF, Anti-CCP, ANA, ENA panel tests, direct radiographs were examined.

Results:

The mean age of the patients was 59.9 ± 12.8 and 88.4% of them were women. 69.3% of patients were limited SSc. At any stage of the disease, 39.1% of all patients had arthralgia and 34.1% had arthritis. The arthritis rate was similar between the SSc groups (p = 0.396). RF and anti-CCP positivity rates were similar between the SSc groups. Although RF and anti-CCP positivity rates were higher in the patient group with arthritis, it was not statistically significant (respectively p=0.563, p=0.072). Interestingly, the lung involvement rate was higher in patients with arthritis (63.3% versus 46.4%) (p=0.015). Other clinical, demographic characteristics, laboratory, and radiographic findings of the patients are shown in Table 1.

Conclusion:

Articular involvement in SSc is a common clinical feature seen in one-third of patients regardless of the type of disease. Although RF and Anti-CCP positivity are more common in patients with arthritis, it was not statistically significant. Interestingly, arthritis is a more common manifestation in patients with lung involvement.

References:

[1]R. D. Sandler, M. Matucci-Cerinic, and M. Hughes, “Musculoskeletal hand involvement in systemic sclerosis,” Seminars in Arthritis and Rheumatism, vol. 50, no. 2. 2020, doi: 10.1016/j.semarthrit.2019.11.003.

Table 1.

Demographic and clinical characteristics of b/tsDMARDs patients

Table-1Limited SSc(n=161)Diffuse SSc(n=71)All patients(n=232)PAge (years) (Mean±SD)60.5 ± 12.758.6 ± 12.959.9 ± 12,80.295Disease duration (years) (Mean±SD)11.5 ± 6.612.4 ± 8.111.8 ± 7,10.384Weight (kg) (Mean±SD)68.2 ± 13.366.2 ± 15.667.6 ± 14.10.331BMI (kg/m2) (Mean±SD)27.6 ± 5.526.2 ± 6.127.1 ± 5.70.102Female, n (%)146 (90.7)59 (83.1205 (88.4)0.097Current and ex smoker, n (%)60 (37.2)18 (25.4)78 (33.6)0.077Digital ulcer, n (%)53 (32.9)34 (47.9)87 (37.5)0.03*Contracture on hand28 (17.4)28 (39.4)56 (24.1)<0,001*Arthralgia, n (%)63 (39.1)29 (31.5)92 (39.7)0.806Arthritis, n (%)52 (32.3)27 (38)79 (34.1)0.396Joint space narrowing on X-ray, n (%)44 (51.2)30 (63.8)74 (55.6)0.160Joint erosion on X-ray, n (%)17 (19.8)14 (29.8)31 (23.3)0.205Acroosteolysis on X-ray, n (%)9 (10.5)16 (34)25 (18.8)0.001*ANA positivity, n (%)155 (96.3)69 (97.2)224 (96.6)0.728Anti-Scl positivity, n (%)41 (28.7)48 (71.6)89 (42.4)<0.001*Anti-centromere positivity, n (%)65 (45.5)10 (14.9)75 (35.7)<0.001*RF positivity, n (%)27 (17.5)14 (20.6)41 (18.5)0.589Anti-CCP positivity, n (%)16 (12.7)7 (11.3)23 (12.2)0.782

P*Independent Samples t Test, Pearson Chi-Square Test, BMI; Body mass index, ANA; Anti nuclear antibody,

RF; Rheumatoid factor, Anti-CCP;Anti- Cyclic citrullinated peptide

Disclosure of Interests:

None declared.

AB0708 HIGH DRUG RETENTION RATES DESPITE B/TSDMARD INTERRUPTIONS IN COVID-19 PANDEMIC CHAOS

Background:

A significant increased risk of COVID-19 related adverse outcomes of the biological or target-directed synthetic DMARDs (b/tsDMARDs) has not yet been reported. For this reason, it is recommended to continue b/tsDMARD treatments with maximum compliance with pandemic measures.

Objectives:

The aim of this study was to evaluate the effects of patients using b/tsDMARDs on drug survival and rheumatic disease control during pandemic.

Methods:

In this study, patients diagnosed with rheumatic disease using b/tsDMARDs and who were followed up during the 12-month period (January 2020-2021) including the onset of the Covid-19 pandemic at Dokuz Eylul University Faculty of Medicine Rheumatology Clinic were evaluated. In the first 3 months of the pandemic (March-June 2020), the patients skipped at least 2 cycles of treatment with the fear of Covid-19 infection except for infection / surgical reasons was considered as a disruption of the drug. The drug retention rates of the patients on b/tsDMARDs treatments during the pandemic process and the factors affecting this situation were evaluated.

Results:

The rate of disrupting their b/tsDMARDs was higher in patients> 65 years of age, with a diagnosis of RA and who needed to come to the hospital for bDMARD treatment (p=0.007, p=0.015 and p=0.004, respectively).

The overall 1-year b/tsDMARD retention rates was found 91%. It was determined that a history of interruption in b/tsDMARD treatments in the first 3 months of the pandemic [OR: 1.28 (CI: 1.042-8.71), p=0.014] and the need to come to the hospital to receive bDMARD [OR: 0.59 (CI: 0.64-13.11), p=0.041] caused unresponsiveness to return to the same bDMARD treatment and a significant increase in the risk of discontinuation of the biologic treatment.

Conclusion:

We conclude that it is important for patients to continue taking b/tsDMARD treatments without interruption in the days past abnormal periods such as pandemic conditions and to make sufficient effort for minimum dose of CS and low disease activity by determining patient-based risk.

Table 1.

Demographic and clinical characteristics of b/tsDMARDs patients

Total (n=521)b/tsDMARD Continue (n=424) (82.4%)b/tsDMARD Interruption (+) (n=97) (17.6%)PMedian (Min./Max.)Median (Min./Max.)Median (Min./Max.)Age, years48 (18/86)47 (18/82)52 (21/81)0.008tDisease Duration, years11,2 (2/43.3)130 (22/490)142 (22/519)0.41tb/ts DMARD Duration, months40 (12/192)40 (12/192)40 (12/156)0.176tn (%)n (%)n (%)Female278 (53.4)225 (53.1)53 (54.6)0.826Most common rheumatic diseases AxSpa or other SpA283 (54.3)232 (54.7)51 (52.6)0.737 RA134 (25.7)100 (23.6)34 (35.1)0.015l PsA44 (8.4)40 (9.4)4 (4.1)0.109 Vasculitis32 (6.1)27 (6.4)5 (5.2)0.817 Others28 (5.4)25 (5.9)3 (3.1)0.338b/tsDMARD at Hospital/Health center140 (26.9)102 (24.1)38 (39.2)0.004l(OR: 0.59)b/tsDMARD administration route (IV)137 (26.3)100 (23.6)37 (38.1)0.005lActive/Progressive Disease92 (17.7)14 (3.3)78 (80.4)<0.001l(OR: 4.8)Start/continue with the same b/tsDMARD55 (10.6)3 (0.7)52 (53.6)<0.001pUnresponsiveness, b/tsDMARD switch16 (3.1)9 (2.1)7 (7.2)0.017pb/tsDMARD stopped permanently/deceased29 (5.6)9 (2.1)20 (20.6)<0.001ffb/tsDMARD retention (Total)474 (91)406 (95.8)68 (70.1)<0.001

tIndependent Samples t Test (Bootstrap), pPearson Chi-Square Test (Monte Carlo), ffFisher freeman Halton Test (Monte Carlo), lLinear-by-Linear Association Test(Monte Carlo, Exact), SD.: Standard deviation; * OR, Odds Ratio,

Disclosure of Interests:

None declared

AB0229 A NATIONAL, MULTICENTER, SECONDARY DATA USE STUDY EVALUATING EFFICACY AND RETENTION OF FIRST-LINE BIOLOGIC TREATMENT WITH TOCILIZUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-LIFE SETTING FROM TURKBIO REGISTRY

Background:

Tocilizumab (TCZ) is a human anti-interleukin (IL)-6 receptor antibody approved in Turkey for the treatment of rheumatoid arthritis (RA).

Objectives:

In this study our purpose was to describe the disease activity, quality of life (QoL), and retention rate in RA patients who were prescribed TCZ as first-line biologic treatment in a real-world setting.

Methods:

Anonymized patient registry of TURKBIO was used based in a national, multicenter, and retrospective context. We conducted a search in the registry between years 2013 and 2020 and included adult RA patients who were prescribed with TCZ as their first-line biologic treatment with a post-TCZ follow-up of at least 6 months. CDAI, DAS28-(ESR), and HAQ-DI scores in 6, 12, and 24 months were obtained. Pairwise comparison was carried out for survey scores across baseline and timepoints. Subgroup analysis for route of TCZ administration was performed. EULAR response criteria were used for response evaluation. Retention of TCZ was evaluated by Kaplan-Meier analysis.

Results:

Overall,130 patients with a mean RA duration of14 years were included in the study. 87.7% of the patients were female and mean age was53 (SD; 15.0). Median duration of follow-up was 18.5 months. Majority (90.8%) of patients were given tocilizumab via intravenous route at baseline. Number of patients with ongoing TCZ treatment and follow-up at 6, 12, and 24 months were 121 (93%), 85 (65%), and 46 (35%), respectively. Remission rates at 6, 12, and 24 months per CDAI (<2.8) and DAS28-(ESR) (<2.6) scores were 61.5%, 44.6%, 30%, and 54.6%, 40.8%, 27.7%, respectively. CDAI, DAS28-(ESR) and HAQ-DI survey scores significantly improved at 6, 12 and 26 months, respectively (p<0.001) (Table 1) in both IV and SC TCZ subgroups. At 6, 12 and 24months 74.8%, 82.5% and 86.4% of patients achieved a EULAR good response respectively. Twenty-three patients (17.6%) discontinued TCZ at 24 months. Of these, 19 patients discontinued due to unsatisfactory response. Retention rates of TCZ at 6, 12, and 24 months were 93%, 84.3%, and 72.2%, respectively (Figure 1).

Conclusion:

TCZ as a first-line biologic treatment was found to be clinically effective in this real-world study with a high retention rate. These results are in line with the results gathered from previous TCZ controlled and real-life studies in which TCZ was found clinically safe and effective.

References:

[1]Haraoui B, Casado G, Czirjak L, Taylor A, Dong L, Button P, Luder Y, Caporali R. Tocilizumab Patterns of Use, Effectiveness, and Safety in Patients with Rheumatoid Arthritis: Final Results from a Set of Multi-National Non-Interventional Studies. Rheumatol Ther. 2019 Jun;6(2):231-243.

[2]Favalli EG, Raimondo MG, Becciolini A, Crotti C, Biggioggero M, Caporali R. The management of first-line biologic therapy failures in rheumatoid arthritis: Current practice and future perspectives. Autoimmun Rev. 2017 Dec;16(12):1185-1195.

[3]Haraoui B, Jamal S, Ahluwalia V, Fung D, Manchanda T, Khraishi M. Real-World Tocilizumab Use in Patients with Rheumatoid Arthritis in Canada: 12-Month Results from an Observational, Noninterventional Study. Rheumatol Ther. 2018 Dec; 5(2): 551–565.

Disclosure of Interests:

Ayten Yazici Speakers bureau: PFIZER, AbbVie, NOVARTIS, Özlem Özdemir Işik: None declared, Ediz Dalkiliç Speakers bureau: AbbVie, UCB Pharma, PFIZER, Roche, MSD, NOVARTIS, Süleyman Serdar Koca Speakers bureau: MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB Pharma, AMGEN, SANOFİ, Yavuz Pehlivan Speakers bureau: PFIZER, NOVARTIS, MSD, CELLTRION, Consultant of: PFIZER, Soner Şenel: None declared, Nevsun Inanc Speakers bureau: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Paid instructor for: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Consultant of: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Grant/research support from: NOVARTIS, PFIZER, ABDI IBRAHIM, JANNSEN, Servet Akar Speakers bureau: LILLY, MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, JANNSEN, UCB Pharma, AMGEN, Paid instructor for: LILLY, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB, AMGEN, Grant/research support from: PFIZER, Sema Yilmaz: None declared, Özgül Soysal Gündüz: None declared, Ayse Cefle Speakers bureau: UCB Pharma, PFIZER, MSD, AbbVie, AMGEN, NOVARTIS, Fatos Onen Speakers bureau: AbbVie, LILLY, MSD, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, JANNSEN, UCB Pharma, AMGEN, İbrahim Etem-MENARINI, Paid instructor for: AbbVie, LILLY, NOVARTIS, GILEAD, PFIZER, ABDI IBRAHIM, UCB Pharma, AMGEN, İbrahim Etem-MENARINI, Grant/research support from: PFIZER

AB0579 INSTRUMENTS FOR SCREENING PSORIATIC ARTHRITIS AMONG PATIENTS WITH PSORIASIS: A SYSTEMATIC LITERATURE REVIEW

Background:

Timely diagnosis is essential for the optimal management of psoriatic arthritis (PsA). Several instruments have been developed for screening PsA among patients with psoriasis. However, a delay in diagnosis is still frequently reported, possibly due to the lack of a wide use of these instruments.

Objectives:

We aimed to identify and compare the reported performance of these instruments with special emphasis on the PsA phenotypes.

Methods:

We conducted a systematic literature search on PubMed until 15 August 2020 using the keyword ‘psoriatic arthritis’. Two independent reviewers identified all studies published in English, that report on the validation, psychometric evaluation or use of an instrument for screening PsA. Any disagreements were resolved by the third investigator. Data on sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were extracted or calculated for each instrument. Additionally, instruments were assessed for their performance in patients with different disease phenotypes.

Results:

A total of 10754 references were screened, and 42 were identified that reported on 15 different screening instruments. Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST), Early Arthritis for Psoriatic Patients questionnaire (EARP) were the most commonly used instruments. There was important variability across studies regarding the sensitivity, specificity, PPV and NPV of these instruments based on the cut-offs for positivity, setting, patient population and disease phenotypes (Table 1). Specificity was higher when patients with a previous diagnosis of other rheumatic diseases were excluded. Lower sensitivity was reported among patients with shorter disease duration and when patients with a prior diagnosis of PsA were excluded from the study, whereas higher sensitivity was reported among patients with prior NSAID use. Screening tools showed differences in sensitivity in different domains (Figure 1).

Figure 1.

Performance Among Patients with Each Domain

Conclusion:

This systematic literature review revealed wide variability in the diagnostic estimates of currently available questionnaire-based screening instruments for identifying PsA among psoriasis patients, depending on study populations and disease phenotypes. There is an unmet need for a screening instrument with a better performance in all disease domains.

Table 1.

Diagnostic estimates of screening tools in different studies

InstrumentNumber of studiesSensitivity%Specificity%PPV%NPV%PASE1824-9138-9518-8813-96PEST1140 – 8537.2-98.623-9647.1-99.3EARP941-97.234-97.214-93.357.5-100TOPAS641-89.129.7-9025.7-91.868-81.6TOPAS-II444-95.880.5-9863.4-95.891-98PsA-Disk questionnaire187.246.458.678.5CONTEST270-76.556.5-9116-8968-95STRIPP191.593.379.697.5SiPAS179877390PASQ267-92.764-81.84383GEPARD277706680Swedish- Psoriasis Assessment Questionnaire163724585PAQ160622687.5SiPAT169699169A novel, short, and simple screening questionnaire186.971.35393.6

PASE: Psoriatic Arthritis Screening and Evaluation, PEST: Psoriasis Epidemiology Screening Tool, EARP: Early Arthritis for Psoriatic Patients questionnaire, TOPAS: Toronto Psoriatic Arthritis Screening Questionnaire, STRIPP: Screening Tool for Rheumatologic Investigation,

SIPAS: Simple Psoriatic Arthritis Screening questionnaire, PASQ: Psoriasis and Arthritis Screening Questionnaire, GEPARD: German Psoriatic Arthritis Diagnostic Questionnaire, PAQ: Psoriatic and Arthritic Questionnaire, SiPAT: Siriraj Psoriatic Arthritis Screening Tool

Disclosure of Interests:

None declared.

AB0437 OESOPHAGEAL DILATATION ON HIGH-RESOLUTION CT CHEST IN SYSTEMIC SCLEROSIS: SIGNIFICANT INDEX?

Background:

Systemic sclerosis (SSc) is chronic, autoimmun multisystem disorder presented by thickening and fibrosis of the skin and internal organs. Esophageal involvement is one of the most common manifestation. Esophageal enlargement on HRCT is a common finding in scleroderma patients and may also be associated with other scleroderma-related clinical findings (1).

Objectives:

The aim of this study to evaluate the association between esophageal dilatation on chest HRCT at diagnosis with the other SSc features.

Methods:

The study was planned for SSc patients registered between October 2007 and September 2020 in Dokuz Eylul University Rheumatology Department database. Demographics, clinical features and medical history were recorded. The baseline HRCT reports were screened in terms of esophageal dilatation. Then, the initial HRCT images were assessed for esophageal dilatation by an experienced chest radiologist according to recommendation of Pitrez et al.

Results:

In our study, there were 233 SSc patients (f:206 M:27, mean age 59.9±12.7 years) 71 (31.4%) of them diagnosed with diffuse disease. Median follow-up of study was 73 (1-272) months. Esophageal dilatation on HRCT was detected in 60 (25.8%) of SSc patients. 67 out of 155 patients (43.2%) had proof of esophageal involvement in esophageal transit scintigraphy. There is no statistical correlation was found between esophageal dilatation on HRCT with gender, smoking, arthritis, pulmonary hypertension and autoantibody subtypes. Development of digital ulcer and telangiectasia is statistically higher in SSc patients with oesophageal dilatation on baseline chest HRCT (p=0.001 and p=0.039, respectively). There was a positive correlation between Modified Rodnan Skin Score (mRss) and esophageal dilatation (r=0.213, p: 0.004).

Conclusion:

HRCT can be a reproducible and non-invasive method for evaluating esophageal dilatation. Presence of esophageal dilatation at baseline HRCT might be indicative for pulmonary involvement and SSc related gastrointestinal complications. Consecutive chest HCRT should be evaluated to obtain more reliable data about the relationship between esophageal dilatation and SSc related clinical features.

References:

[1]Pitrez EH, Bredemeier M, Xavier RM et al.Ooesophageal dysmotility in systemic sclerosis:comparison of HRCT and scintigraphy. Br J Radiol 2006; 79: 719–24.

Table 1.

Clinical and demographic characteristics of the presence of esophageal dilatation on HRCT

Esophageal dilatation on HRCTTotal (n=233)Yes (n=60, 25.8%)No (n=173, 74.2%)pMean±SD.Mean±SD.Mean±SD.Age, years59.9±12.759.7±12.260.1 ±12.6>0.05n%n%n%Female20688,4%5388,3%14986,1%>0.05Smoking7933,9%1931,7%6034,7%>0.05Diffuse SSc7130,5%2338,3%4425,4%>0.05Overlap syndrome3314,2%813,3%2514,5%>0.05Pulmonary fibrosis11850,6%4270,0%7643,9%>0.05Arthritis8034,3%2338,3%5632,4%>0.05Telengiectasia15667,0%4880,0%10560,7%0,039Digital ulcer8737,3%3456,7%5129,5%0,001Anti-Scl 70 (+)8938,2%2846,7%5934,1%>0.05Anti-centromer (+)7532,2%1525,0%5934,1%>0.05

Disclosure of Interests:

None declared

AB0479 LONGTERM RETENTION RATE OF CERTOLIZUMAB PEGOL IN AXIAL SPONDYLOARTHRITIS IS HIGHER: DATA FROM TURKBIO

Background:

Choosing the best treatment strategy for a patient is one of the most difficult issues in modern rheumatology, as there are various factors affecting drug therapy in chronic diseases, such as efficacy, safety, and compliance. Physicians take care of long-term retention rate and responses for discontinuation of candidate drug.

Objectives:

The purpose of this study to assess the drug survival of certolizumab pegol (CZP) in patients with axial spondyloarthritis (ax-SpA) and to identify the predictors and reasons for discontinuation.

Methods:

Data on patient characteristics, demographics, diagnosis, duration of disease, treatment and outcomes have been collected since 2011 in Turkish Biologic (TURKBIO) Registry. By the end of December 2020, 410 ax-SpA patients received CZP and were included. Kaplan Meier plot was used for drug survival analysis. Cox regression analysis was performed to evaluate the predictor associated with drug survival.

Results:

During the median 54 months follow-up, 92 (22.4%) patients discontinued the CZP treatment. The reasons for discontinuation: ineffectivity was 58.7% (n=54), adverse events was 6.5%, pregnancy was 3.3% and surgery was 4.3%. The baseline characteristics of patients continue with CZP and discontinuation due to ineffectiveness were shown in the Table 1. Patients who discontinued CZP had higher HAQ, BASFI and BASDAI values. Moreover, they were more co-treated with NSAIDs and csDMARDs. At the month 36, retention rate of CZP was 71.5% in patients with ax-SpA (Figure 1).

Conclusion:

Real life experience from this nationwide TURKBIO registry show higher long-term retention rate of CZP in ax-SpA. Higher baseline disease activity and functional limitation predict discontinuation of CZP. Adding NSAIDs and csDMARDs to the treatment of the patient with poor prognosis cannot increase retention rates.

Figure 1

Drug survival of CZP in patients with Ax-SpA

Table 1.

Baseline characteristics of ax-SpA patients who continue and discontinue CZP

All patients (n=410)Continue to CZP (n=318)Discontinue to CZP* (n=54)pFemales, n (%)185 (49,7)157 (49,4)28 (51,9)0,736Age, years42 (34-49)41 (34-49)45 (34-54)0,064Symptom duration, years11 (7-17)11 (6-16)12 (8,5-20)0,054HLA-B27, n (%)150 (63,8)129 (64,5)21 (60)0,609Previous bDMARDs, n (%)Adalimumab54 (14,5)42 (13,2)12 (22,2)0,082Etanercept53 (14,2)40 (12,6)13 (24,1)0,025Golimumab11 (3)7 (2,2)4 (7,4)0,060Infliximab39 (10,5)35 (11)4 (7,4)0,425Co-treated drugs, n (%)NSAID206 (55,4)169 (53,1)37 (68,5)0,036Methotrexate35 (9,4)22 (6,9)13 (24,1)<0,001Sulphasalazine61 (16,4)40 (12,6)21 (38,9)<0,001Leflunomide5 (1,3)2 (0,6)3 (5,6)0,023ESH, mm/h21,5 (10-37)21 (10-37)23 (10-34)0,999CRP, mg/dl7 (3-20)7 (3-20)7 (3-22)0,727HAQ0,63 (0,25-0,94)0,5 (0,25-0,88)0,75 (0,38-1,25)0,009BASFI21 (7-45)20,5 (6-41)31 (13-58)0,011BASDAI30,5 (13-52)30 (12-50)43 (23-61,5)0,002ASDAS2,7 (1,8-3,7)2,7 (1,8-3,6)2,9 (2,3-4)0,062

*Discontinue due to ineffectivity.

References:

[1]Iannone F, et al. Effectiveness of Certolizumab-Pegol in Rheumatoid Arthritis, Spondyloarthritis, and Psoriatic Arthritis Based on the BIOPURE Registry: Can Early Response Predict Late Outcomes? Clin Drug Investig. 2019;39(6):565-575.

Disclosure of Interests:

None declared.

POS0027 SECULAR TRENDS IN BASELINE CHARACTERISTICS, TREATMENT RETENTION AND RESPONSE RATES IN 27189 BIO-NAÏVE AXIAL SPONDYLOARTHRITIS PATIENTS INITIATING TNFI – RESULTS FROM THE EUROSPA COLLABORATION

Background:

Knowledge of changes over time in baseline characteristics and tumor necrosis factor inhibitor (TNFi) response in bio-naïve axial spondyloarthritis (axSpA) patients treated in routine care is limited.

Objectives:

To investigate secular trends in baseline characteristics and retention, remission and response rates in axSpA patients initiating a first TNFi.

Methods:

Prospectively collected data on bio-naïve axSpA patients starting TNFi in routine care from 15 European countries were pooled. According to year of TNFi initiation, three groups were defined a priori based on bDMARD availability: Group A (1999–2008), Group B (2009–2014) and Group C (2015–2018). Retention rates (Kaplan-Meier), crude and LUNDEX adjusted1 remission (Ankylosing Spondylitis Disease Activity Score (ASDAS) <1.3, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <20) and response (ASDAS Major and Clinically Important Improvement (MI/CII), BASDAI 50) rates were assessed at 6, 12 and 24 months. No statistical comparisons were made.

Results:

In total, 27189 axSpA patients were included (5945, 11255 and 9989 in groups A, B and C).

At baseline, patients in group A were older, had longer disease duration and a larger proportion of male and HLA-B27 positive patients compared to B and C, whereas disease activity was similar across groups.

Retention rates at 6, 12 and 24 months were highest in group A (88%/81%/71%) but differed little between B (84%/74%/64%) and C (85%/76%/67%).

In all groups, median ASDAS and BASDAI had decreased markedly at 6 months (Table 1). The ASDAS values at 12 and 24 months and BASDAI at 24 months were higher in group A compared with groups B and C. Similarly, crude remission and response rates were lowest in group A. After adjustments for drug retention (LUNDEX), remission and response rates showed less pronounced between-group differences regarding ASDAS measures and no relevant differences regarding BASDAI measures.

Conclusion:

Nowadays, axSpA patients initiating TNFi are younger with shorter disease duration and more frequently female and HLA-B27 negative than previously, while baseline disease activity is unchanged. Drug retention rates have decreased, whereas crude remission and response rates have increased. This may indicate expanded indication but also a stable disease activity threshold for TNFi initiation over time, an increased focus on targeting disease remission and more available treatment options.

References:

[1]Arthritis Rheum 2006; 54: 600-6.

Table 1.

Secular trends in baseline characteristics, treatment retention, remission and response rates in European axSpA patients initiating a 1st TNFi

Baseline characteristicsGroup A(1999–2008)Group B(2009–2014)Group C(2015–2018)Age, years, median (IQR)57 (49–66)51 (42–60)46 (37–56)Male, %666057HLA-B27, %877772Years since diagnosis, median (IQR)5 (1–12)2 (0–8)2 (0–7)Smokers, %232425ASDAS, median (IQR)3.5 (2.8–4.1)3.4 (2.8–4.1)3.5 (2.8–4.1)BASDAI, median, (IQR)57 (42–71)59 (43–72)57 (41–71)TNFi drug, % (Adalimumab /Etanercept / Infliximab /Certolizumab / Golimumab)22 / 35 / 43 / 0 / 037 / 21 / 20 / 4 / 1827 / 28 / 24 / 8 / 13Follow up6 months12 months24 monthsGr AGr BGr CGr AGr BGr CGr AGr BGr CRetention rates, %, (95% CI)88 (88–89)84 (83–85)85 (84–86)81 (80–82)74 (74–75)76 (75–76)71 (70–72)64 (63–65)67 (66–68)ASDAS, median, (IQR)1.8 (1.2–2.8)1.9 (1.2–2.8)1.8 (1.2–2.6)1.9 (1.3–2.6)1.7 (1.2–2.5)1.6 (1.1–2.4)1.9 (1.4–2.6)1.7 (1.1–2.4)1.5 (1.1–2.2)ASDAS inactive disease, %, c/L28 / 2528 / 2430 / 2624 / 1932 / 2434 / 2623 / 1634 / 2039 / 23ASDAS CII, %, c/L57 / 5159 / 5063 / 5461 / 5063 / 4767 / 5159 / 4168 / 4074 / 45ASDAS MI, %, c/L31 / 2732 / 2737 / 3232 / 2637 / 2741 / 3130 / 2042 / 2546 / 28BASDAI, median, (IQR)23 (10–40)26 (11–48)24 (10–44)21 (10–38)23 (10–42)20 (8–39)22 (9–40)20 (8–39)16 (6–35)BASDAI remission, %, c/L44 / 4040 / 3443 / 3645 / 3645 / 3450 / 3844 / 3048 / 2956 / 34BASDAI 50 response, %, c/L53 / 4750 / 4253 / 4557 / 4656 / 4258 / 4457 / 3960 / 3563 / 38

Gr, Group; c/L, crude/LUNDEX adjusted.

Acknowledgements:

Novartis Pharma AG and IQVIA for supporting the EuroSpA Research Collaboration Network.

Disclosure of Interests:

Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Sara Nysom Christiansen Speakers bureau: BMS and GE, Grant/research support from: Novartis, Simon Horskjær Rasmussen: None declared, Anne Gitte Loft Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Grant/research support from: Novartis, Ulf Lindström: None declared, Jakub Zavada: None declared, Florenzo Iannone: None declared, Fatos Onen: None declared, Michael J. Nissen Speakers bureau: Novartis, Eli Lilly, Celgene, and Pfizer, Consultant of: Novartis, Eli Lilly, Celgene, and Pfizer, Brigitte Michelsen Consultant of: Novartis, Grant/research support from: Novartis, Maria Jose Santos Speakers bureau: AbbVie, Novartis, Pfizer, Gary Macfarlane Grant/research support from: GlaxoSmithKline, Dan Nordström Consultant of: Abbvie, BMS, MSD, Novartis, Pfizer, Roche, UCB, Manuel Pombo-Suarez: None declared, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Irene van der Horst-Bruinsma Speakers bureau: Abbvie, BMS, MSD, Novartis, Pfizer, Lilly, UCB, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Johan Askling: None declared, Bente Glintborg Grant/research support from: Pfizer, Biogen, AbbVie, Karel Pavelka Speakers bureau: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Consultant of: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Elisa Gremese: None declared, Nurullah Akkoc: None declared, Adrian Ciurea Speakers bureau: Abbvie, Eli-Lilly, MSD, Novartis, Pfizer, Eirik kristianslund: None declared, Anabela Barcelos: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene, Amgen, GSK, Anna-Mari Hokkanen Grant/research support from: MSD, Carlos Sánchez-Piedra: None declared, Ruxandra Ionescu Speakers bureau: Abbvie, Amgen, Boehringer-Ingelheim Eli-Lilly,Novartis, Pfizer, Sandoz, UCB, Ziga Rotar Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Marleen G.H. van de Sande: None declared, Arni Jon Geirsson: None declared, Mikkel Østergaard Speakers bureau: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth, Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth, Merete L. Hetland Speakers bureau: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis.

SAT0097 DO COMORBIDITIES IMPACT PERSISTENCE OF FIRST TUMOR NECROSIS FACTOR INHIBITOR TREATMENT IN RHEUMATOID ARTHRITIS? DATA FROM TURKBIO

Background:

Studies indicate that patients with rheumatoid arthritis (RA) are at increased risk of developing several comorbid disorders. Comorbidities affect treatment decisions, the effectiveness of the treatment, quality of life, RA prognosis, and survival rate [1].

Objectives:

The aim of thisstudyto investigate the impact of comorbidity on the first TNF inhibitor treatment persistence in RA.

Methods:

In the TURKBIO database, patients with an ICD 10-diagnosis of RA (M05 or M06) who started TNF inhibitor therapy between January 2011 and June 2019 were enrolled. Demographic and clinical characteristics, acute phase reactants, disease activity scores (DAS 28 CRP, HAQ, CDAI, VAS global), initial comorbidities and numbers, drug persistence, were evaluated. Kaplan-Meier plots and Cox proportional hazard regression analyses were performed.

Results:

A total of 1172 patients >18 years of age treated with TNF-α inhibitors were included in the study. The most prevalent comorbidities were: hypertension in 262 patients (32.6%), obesity in 254 (32.6%), osteoporosis in 178 (22.3%), chronic lung disease in 143 (17.9%) and depression in 126 (15.8%). The baseline characteristics are summarised in Table 1. The presence of comorbidity did not affect the survival rate of the first TNF inhibitor therapy in the RA patients (p: 0.65). Comorbidities had no effect on DAS28 CRP (> 1.2 reduction) responses at 6 and 12 months of treatment (p: 0.18, p: 0.83, respectively). As the mean disease duration increases, the persistence of the first TNF inhibitor decreases by 5%.

Conclusion:

This study demonstrated the increasing burden of comorbidities in RA. However, it suggested that the presence and number of comorbidities did not influence the rate of persistence in the first TNF inhibitor drug and the response to treatment.

References:

[1] Gabriel, S.E. and K. Michaud,Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases.Arthritis research & therapy, 2009.11(3): p. 229.

Disclosure of Interests:

None declared

FRI0491 IS THERE A RELATIONSHIP BETWEEN VOGT-KOYANAGI-HARADA AND INFLAMMATORY RHEUMATOLOGICAL DISEASES

Background:

Vogt-Koyanagi-Harada Disease (VKHD) is a systemic autoimmune disease characterized by bilateral granulomatous panuveitis associated with systemic symptoms, including neurological, dermatological and audiovestibular systems. Due to its systemic nature, it may accompany with other autoimmune conditions. However, there is a considerably limited number of reports on the association of VKHD and rheumatologic diseases.

Objectives:

To investigate the relationship between VKHD and inflammatory rheumatological diseases.

Methods:

Patients who had bilateral granulomatous uveitis and fulfilled the 2001 revised diagnostic criteria for VKHD were included in our study. All patients were systematically reviewed in terms of the presence of any rheumatological manifestations including connective tissue diseases, spondyloarthritis (SpA), vasculitis, Behcet’s disease and sarcoidosis.

Results:

Demographic findings: There were fifteen patients in the study (86,7%,female), the mean age at diagnosis was 31,2 ± 11,1 years.

Comorbidities: Six patients (4 hashimoto thyroiditis, 2 diabetes mellitus) had comorbid diseases.

Rheumatological findings: Mechanical back pain in 4 patients, 1 patient had morning stiffness without any other SpA related features; 2 patients had inflammatory arthralgias in small joints, 4 patients had sicca symptoms, 1 patient had arthritis in knee joint, 3 patients had oral aphthae and 1 patient had photosensitivity.

Laboratory tests and autoantibodies: The acute phase reactants were within normal ranges. The mean CRP value at the time of diagnosis was 2,7 ± 3,2 mg/L and ESR was 14,4 ± 9,2 mm/h. Two (15,3%) out of 13 patients had high serum ACE levels. RF, anti-CCP and anti-dsDNA were negative in all patients. ANA was positive (>1/160 titers) in 4 patients (28,6%) and 3 patients had a titer above 1/320. Anti-ENA profile was positive in 2 patients with anti-SS-B and anti-histone components. MPO-ANCA was positive in one patient.

HLA test: HLA-B27 was negative in all patients. HLA-B51 and B18 were positive in 2 patients.

Radiographic findings: One patient had heel enthesitis on X-ray, 4 patients had bilateral grade 1 and one patient had unilateral grade 2 sacroiliitis. None of them fulfilled the Modified New York criteria for radiographic sacroiliitis. Hand X-rays of all patients were normal. One patient had reticular density on chest X-ray.

Pathergy: The pathergy test was negative in all patients.

Capilleroscopy: Four patients had pathological capilleroscopy findings (3 patient tortuous loops, 1 patient tortuous loops and microhemorrhages).

Conclusion:

This study suggests that; 1) inflammatory arthralgias and sicca symptoms were the most common rheumatological findings, 2) the frequency of SpA related features were not increased in VKHD, 3) increased autoantibody frequency, particularly in high titers of ANA could be seen in VKHD possibly reflecting the autoimmune nature of the disease, 4) even though there were signs of rheumatic diseases, none of the patients were grouped into any rheumatologic diagnostic classification.

Demographic findings and rheumatological manifestations in VKHD patientsVKHD patients (n=15)Females,n (%)13 (86,7)Age,yrs (mean ± std)34,6 ± 12,6Age of diagnosis, yrs (mean±std)31,2 ± 11,1CRP baseline (mean±std)2,7 ± 3,2 mg/LESR baseline (mean±std)14,4 ± 9,2 mm/HHigh ACE levels,n(%)2/13 (15,3)RF positivity,n(%)0/14 (0)Anti-CCP positivity,n (%)0/6 (0)ANA positivity,n(%)4/14 (28,6)ANA pattern,(n)Homogeneous (2)Nuclear (1)Homogeneous speckled (1)Anti-dsDNA positivity,n(%)0/11 (0)Anti-ENA profile positivity,n(%)2/14 (14,2)ANCA positivity,n(%)1/12 (8,3)Pelvis X-Ray abnormality,n(%)Sacroiliitis (n)5/12 (41,7)Bilateral grade 1 (4)Unilateral grade 2 (1)Capilleroscopy abnormality,n(%)4/9 (44,5)Pathergy,n (%)0/12 (0)

Disclosure of Interests:

None declared

THU0378 DO COMORBIDITIES DECREASE THE FIRST TNF-INHIBITOR RETENTION AND TREATMENT RESPONSE IN AXIAL SPONDYLOARTHRITIS PATIENTS? DATA FROM TURKBIO

Background:

The frequency of comorbidities has increased in spondyloarthritis patients compared to the general population. The effect of comorbidities on tumour necrosis factor alpha inhibitor (TNFi) drug retention and treatment response has not been well evaluated.

Objectives:

The purpose of this study to assess the impact of comorbidities on the first TNFi drug survival and treatment response in patients with axial spondyloarthritis (axSpA) registered in theTURKBIOdatabase.

Methods:

In this study, the frequency of comorbidities, disease activity scores at baseline and month 6 and drug retention were recorded in AxSpA patients iniating first TNFi treatment between 2011 and 2019. Kaplan Meier plot and log rank tests were used for drug survival analysis. Cox regression analysis with HR was performed to evaluate the correlation between comorbidities and drug survival.

Results:

There were 2428 patients with AxSpA (39.3% female) who used their first TNFi during the study period. Among them, a total of 770 (31%) had at least one comorbid disease. Hypertension was the most common comorbidity (9.7%), followed by the affective disorders (8%) and chronic lung disease (5.8%). The baseline characteristics of patients are shown in Table 1.The presence of any comorbidity did not impact the first TNFi retention (Figure 1). When comorbidities were analysed seperately, we found that only history of cerebrovascular event was negatively associated with drug retention rate (HR: 6.9, p:0.008). There was no statistically significant difference in Bath AS Disease Activity Index 50% (BASDAI50) response between patients with and without comorbidity at 6 months. Less axSpA patients with comorbidity achieved a ASDAS score ≤ 2.1 compared to patients without comorbidity at 6 months.

Table 1.

Baseline Characteristics of Patients

Radiographic Spondyloarthritis, n (%)2318 (95.5)Female, n(%)954 (39.3)Age, year42.2±11.8Age at diagnosis, years32.5± 11.3Age at initial TNFi, years39.4 ± 11.1Symptom duration, years9.7± 7.5Time to initial TNFi, years7±6.8HLA-B27- positivity, n (%)1144 (47.1)Smokers, n (%)1068 (44)Baseline BASDAI35.5±22.2Baseline ASDAS-CRP2.8±1.1Baseline CRP (mg/L)15.7±24.4VAS global patient46.6±28.7

-Quantitative variables are presented as mean ± SD, and qualitative variables are presented as frequency and percentage

-ASDAS-CRP, Ankylosing Spondylitis Disease Activity Score using C-reactive protein VAS, visual analogue scale

Conclusion:

The results of this study demonstrated that the presence of previous cerebrovascular event decreased the first TNFi survival in patients with axSpA. It also suggested that comorbidities might decrease TNFi treatment response.

Disclosure of Interests:

None declared

THU0390 THE INFLUENCE OF OBESITY ON RETENTION AND TREATMENT RESPONSE OF SECUKINUMAB IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS: REAL LIFE DATA FROM THE TURKBIO REGISTRY

Background:

Axial spondyloarthritis (axSpA) is a chronic, inflammatory disease that primarily affects the axial skeleton. Secukinumab is a human monoclonal antibody that binds to the protein interleukin (IL)-17A. Although some studies showed that obesity had a negative effect on the efficacy of tumor necrosis factor alpha inhibitor (TNFα -i) treatment in AS patients (1), no data is available for secukinumab.

Objectives:

To evaluate the effect of obesity on the treatment response and drug survival of secukinumab in patients with axSpA.

Methods:

We performed an observational cohort study based on the TURKBIO between 2018-2020. A total of 185 patients were included in the study. The patients were divided into three groups as obese (BMI≥30 kg/m2), overweight (BMI:25-30 kg/m2), and normal (BMI<25 kg/m2). Disease activity was evaluated at baseline and 3, 6 and 12 months of secukinumab therapy. Clinical response was evaluated as achievement of BASDAI50, ASAS20/40, and ASDAS-Clinical and improvement (CII and MI) rates.

Results:

185 axSpA patients were identified in the registry; 135 (72%) had available BMI data. Thirty nine (28.8%) patients were obese. The mean age of obese patients was higher (p=0.002). The frequency of HLA-B27 and male gender was lower in obese group (p=0.012 and p=0.013, respectively). There was no significant difference between groups in terms of clinical response parameters at 3, 6 and 12 months (Table 1). Drug retention rates were higher in biologic naive patients(p=0.007) (Figure 1).

Table 1(BMI <25) (n=33)(BMI 25-30)(n=63)(BMI ≥ 30)(n=39)PAll patients (n=185)Age (years)40.2±11.345.7±11.750.0±10.60.002 *45.2±11Male Gender n (%)25 (75.8)34 (54.0)16 (41.1)0.012 **104 (56.2)HLA-B27 (+) n (%)14 (73.6)37 (84.0)11 (44.0)0.013 **76 (64.3)Prior Naive/1/≥2 bDMARD n (%)12 (36.3)/9 (27.3)/12 (36.3)17 (26.9)/13 (20.6)/33 (52.4)10 (25.6)/14 (35.8)/27 (69.2)0.30256 (30.3)/ 49 (26,5)/ 80 (43,2)ASAS20 response¶13 (61.9)/11 (57.9)/4 (57.1)19 (48.7)/16 (59.3)/8 (42.1)11 (40.7)/7 (29.1)/3 (50.0)0.345/0.073/0.88659 (518)/47 (49.5)/20 (42.6)ASAS40 response¶9 (42.9)/7 (36.8)/3 (42.9)15 (39.5)/10 (37)/1 (5.3)6 (24)/5 (20,8)/3 (50.0)0.334/0.386/0.01240 (35.0)/29 (30.5)/11 (23.4)BASDAI50 response ¶10 (47.6)/9 (47.4)/4 (57.1)15 (39.5)/11 (40.5)/3 (15.8)9 (34.6)/5 (21.7)/3 (50.0)0.634/0.192/0.07748 (42.1)/37 (38.9)/16 (34.0)ASDAS-CII ¶3 (14.3)/5 (26.3)/1 (14.3)6 (17.6)/8 (30.8)/5 (27.8)6 (23.1)/5 (21.7)/2 (33.3)0.237/0.162/0.53123 (21.4)/22 (23.6)/11 (23.9)ASDAS-MI ¶5 (23.8)/3 (15.8)/0 (0)8 (23.5)/6 (23.1)/2 (11.11 (3.8)/1 (4.3)/1 (16.7)0.237/0.162/0.53118 (16.8)/18 (19.3)/8 (17.4)

§; Mean±SD. ¶; at 3/6/12 Months, n (%),*One-way ANOVA test, ** Pearson Chi-Sqaure Test

Figure 1

Conclusion:

This study demonstrated that obesity had no impact on the efficacy and retention of secukinumab treatment in patients diagnosed with axSpA. The drug survival was found to be higher among biologic-naive axSpA patients compared to biologic-experienced.

References:

[1]Ottaviani S.et al. ‘’Body mass index influences the response to infliximab in ankylosing spondylitis’’,Arthritis Res Ther 2012; 14: R11

Disclosure of Interests:

None declared

SAT0128 ARE THERE ANY DIFFERENCES BETWEEN ADULT-ONSET RHEUMATOID ARTHRITIS PATIENTS AND LATE-ONSET RHEUMATOID ARTHRITIS PATIENTS IN TERMS OF USE OF BIOLOGICAL DRUGS AND DRUG RETENTION RATE? RESULTS FROM THE TURKBIO REGISTRY

Background:

Rheumatoid arthritis(RA) is one of the most frequent rheumatic disease, and the age of onset is between 30-50 years old. Late-onset RA(LORA) is usually defined as RA with onset at age 60 or over.

Objectives:

To investigate the choice, effectiveness and the retention rate of biological drugs in LORA patients.

Methods:

TURKBIO registry is the Turkish version of Danish DANBIO rheumatological database which has been established in 2011. We studied RA patients in TURKBIO registry cohort between the dates of 2011 and 2020. All patients fulfilled the American College of Rheumatology criteria for RA and were classified into two groups based on their age at symptom onset: adult-onset RA(>18-<60 years; AORA) and LORA(≥60 years). In both groups, demographical, clinical and laboratory variables; disease activity, current and previous treatment were compared.

Results:

From 10 centers, 2111 RA patients recruited, and 8.8% of them was LORA patients. In LORA, the frequency of female was less than AORA. While, there was no difference between LORA and AORA in terms of erosion presence and RF positivity, antiCCP positivity was more frequent in LORA group. The use of antiTNF was lower, and the use of rituximab was more frequent in LORA. At 12 months after bDMARDs therapy, serum CRP and ESR levels and DAS28-CRP showed higher changes compared to baseline values in LORA. Although the mortality rate was higher in LORA, the adverse reactions were reported to be higher in AORA, and most common advers reaction was infections in both groups(Table). The longest survival was observed in infliximab and rituximab(median 22 and 20months) in LORA, in rituximab and golimumab(median 16 and 12months) in AORA.

Conclusion:

The frequency of LORA who uses bDMARDs was 8.8% in our database. In the elderly patient population, there are some reservations about the use of biological drugs in general due to several co-morbidities and concommitant drug used. Although data on this issue are limited, appropriate biological use can be effective and reliable in required patients.

References:

[1]Zulfigar AA, Niazi R, Pennaforte JL, Andres E. Late-onset rheumatoid arthritis: clinical, biyological, and therapeutic features about a retrospecttive study. Geriatr Psychol Neuropsychiatr Viell 2019;17:51-62

Table.

Comparison of demographic, laboratory findings and biological treatment

(median;25-75)n(%)AORA (<60)(n:1925)LORA (≥60)(n:186)pAge (year)54 (43-61)71 (68-74)<0.001Disease duration (year)11.4 (7-18)6 (4-9)<0.001Gender (Female)1562 (81)124 (67)<0.001Anti-CCP positivity747 (62)65 (72)0.044RF positivity721 (61)63 (70)0.085Erosion presence486 (56)41 (62)0.955Drug survival (months)18 (6-44)18 (4-31)0.046Concomitant csDMARDsMTX629 (34)39 (22)0.001SZP146 (8)13 (7)0.781LEF501 (27)35 (20)0.032bDMARDsAntiTNF1068 (56)73 (39)<0,001TCZ304 (16)20 (11)0,069TOFA294 (15)27 (15)0,784RTX439 (23)57 (31)0,016ABA298 (16)34 (18)0,317Response ΔESH-6 (-21-4)-18 (-36--3)0.016(12 months) ΔCRP-2 (-12-0.6)-9.3 (-28--0.1)0.014ΔDAS28-CRP-1.3 (-3--0.1)-2.2 (-3--1)0.023ΔHAQ-0.3 (-0.8-0)-0.4 (-0.8--0.1)0.114Adverse effects440 (23)32 (17)0.077Malignancy9 (0,5)3 (1.6)0.082Infection192 (10)10 (5)0.042Allergy63 (3)4 (2)0.404Dermatitis62 (3)1 (0,5)0.040Death18 (0.9)7 (4)0.004Other136 (7)11 (6)0.556

Acknowledgments :

None

Disclosure of Interests: :

None declared

SAT0543 PREVALENCE OF FABRY’S DISEASE IN MILD AND SEVERE FMF PATIENTS

Background:

Fabry disease (FD) is a rare metabolic disorder caused by the mutations in the α-galactosidase A (GLA) gene. FD patients present with heterogeneous clinical manifestations, which may overlap with systemic diseases including familial Mediterranean fever (FMF). Recurrent episodes of fever, abdominal pain, and arthralgias can be observed in both disorders and this may lead to misdiagnosis.

Objectives:

To investigate FD prevalence in mild and severe FMF patients.

Methods:

A total of 66 FMF patients, according to the Tel-Hashomer criteria, were included in the study. Patients were grouped into mild (Group 1) and severe (Group 2) subsets according to the severity score. α-GLA enzyme activity and mutations in the GLA gene were performed. Demographic features, clinical findings, MEFV mutations and treatments were recorded.

Results:

The clinical and demographical characteristics of the patients were given in Table 1. In severe form, 27 patients were using biological drug and 40.7% had amyloidosis. Symptoms related to FD including hypohidrosis, acroparesthesias, and painful neuropathies, were not different between the groups. Only one patient in group 1 had a low GLA enzyme activity (0.1 nmol/h/ml;Normal >2.5) which also had mutations in the GLA gene but MEFV mutation test was negative. (Table 2). This patient was a 39-year-old female with recurrent abdominal pain, distal extremity pain and the presence of fever during the attacks. She was heterozygous for R301Q. In detailed history, she reported mild acroparesthesias, hypohidrosis, and tinnitus.

Table 1.

Demographic and clinical findings

All patientsn: 66Group 1n: 32Group 2n: 34p-valueAge, median (min./max.)34 (17/64)27 (17/59)36 (18/64)0.192Male, n (%)36 (54.5)14 (43.8)22 (64.7)0.137Disease duration, median (min./max.)20.5 (1/57)12.5 (2/50)25 (1/57)0.006Family history of FMF, n (%)41 (62.1)22 (68.8)19 (57.6)0.443Alpha-galactosidase A (nmol/h/ml), median (min./max.)5.9 (0.1/16)5.6 (0.1/9.6)6 (3.1/16)0.330Abdominal pain, n (%)58 (87.9)31 (96.9)27 (79.4)0.030Fever, n (%)54 (81.8)25 (78.1)29 (85.3)0.532Arthritis, n (%)34 (51.5)10 (31.3)24 (70.6)0.003Pleuritis, n (%)31 (47)19 (59.4)12 (35.3)0.083Painful neuropathy, n (%)23 (34.8)13 (40.6)10 (29.4)0.440Acroparesthesias, n (%)9 (13.6)6 (18.8)3 (8.8)0.240Angiokeratomas, n (%)0 (0)0 (0)0 (0)-Cardiac abnormalities1 (1.5)1 (3,1)0 (0)0.485Tinnitus, n (%)4 (6.1)3 (9.4)1 (2.9)0.274Hearing loss, n (%)2 (3)2 (6.2)00.086Hypohydrozis, n (%)2 (3)1 (3.1)1 (2.9)0.965Cornea verticillata, n (%)0 (0)0 (0)0 (0)-Proteinüria, n (%)13 (19.7)2 (6.3)11 (32.4)0.012Colchine dosing (mg/day), median (min./max.)2 (1/3)1 (1/2)2 (1/3)<0.001Table 2.

MEFV mutant alleles and GLA mutations

All patientsn: 66Group 1n: 32Group 2n: 34Alpha -galactosidase A (GLA) gene mutations, n (%)1 (1.5)1 (3.1)0 (0)M694V mutations, n (%)47 (35.6)17 (26.5)30 (44.1)Non-M694V mutations, n(%)36(27.2)20 (31.2)16 (23.5)

Conclusion:

In this study, we showed the following: 1) the FD rate in the total FMF group was 1.5% (3.1% in group 1), 2) none of the patients in the severe FMF subset had abnormal enzyme activity or mutations related with FD, 3) symptoms related with FD such as hearing loss, hypohidrosis, acroparesthesias, and painful neuropathies also noted in FMF patients particularly in the milder group. Based on our results, FD should be considered in the differential diagnosis of FMF particularly in patients with atypical symptoms.

Disclosure of Interests:

None declared

FRI0099 THE IMPACT OF BIOLOGICAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS ON THE COURSE OF RHEUMATOID ARTHRITIS-ASSOCIATED LUNG DISEASE

Background:

Pulmonary involvement is one of the frequent extra-articular manifestations of rheumatoid arthritis (RA) (1). Biological disease-modifying anti-rheumatic drugs (bDMARDs) are effectively used in the treatment of musculoskeletal findings of RA but their effect on RA-associated lung disease is unclear.

Objectives:

The aim of this retrospective study is to evaluate and compare different bDMARD treatments used in RA patients with RA-associated lung disease.

Methods:

All RA patients who received bDMARDs between 2008 and 2018 in a single rheumatology centre and had thorax high-resolution computed tomography (HRCT) were reviewed for the findings of lung involvement. Patients with positive finding were included in the study. Following the biologic treatment, whether there was a progression/regression in lung involvement was evaluated by comparing the baseline and the latest thorax HRCT findings. Clinical and laboratory data were collected from medical records.

Results:

A total of 40 patients (mean age:62.4 years; 72.5% women) were included in the study. Clinical and demographic characteristics of patients are summarized in Table 1. During the mean 107.43 ± 65 months follow-up period, HRCT findings remained stable in 31 patients (76%) and improved in one (2.5%), while 7 patients (17.5%) had progress in their lung involvement. When patients with and without progress were compared, lung involvement at the diagnosis of RA and the presence of respiratory symptoms at bDMARDs initation was found to be more frequent in the first group (p=0.023 and p=0.020, respectively). Mean ESH values at bDMARDs initation were also higher in patients who had progress (p=0.006). There was no significant difference between the groups in the age, sex, type of bDMARDs used or other baseline laboratory data. Logistic regression analysis showed that lung involvement at the diagnosis of RA was a significiant independent risk factor for the progress (OR: 11.0, 95% CI=1.48-81.60). There was no statistically difference on progression of HRCT findings between patients received TNFi (n=22) and non-TNFi biologics (n=18), (p=1.00). The mean drug survival of first bDMARD also was not statistically different between groups (40.83±21.6 months in non-TNFi group and 42.23±40.50 months in TNFi group (p=0.90)). 5/18 (%27.8) patients in the non-TNFi group and 1/22 (%4.5) in TNFi group had died during the follow-up (p=0.14)

Table 1.

Demographic and clinic characteristics of the patients at the Initiation of BDMARDs.

CharacteristicsN=40Male/Female, n11/29Age at bDMARDs initiation, years (mean±SD)56,51±10.53Age at the diagnosis, years (mean±SD)49,38±11,7Disease duration at bDMARDs initiation, years (mean±SD)7,15±5,53Past or current smoker, n (%)21/40 (52.5)RF positivity, n (%)29/40 (72.5)ACPA positivity, n (%)35/39 (89.7)Anti-SSA positivity n (%)3/9 (33.3)Patients with Sjögren’s syndrome, n (%)5/10 (50)ESR at bDMARDs initiation, (mm/h)38,37 ± 22,2CRP at bDMARDs initiation, (mg/l)16,08 ± 14,54DAS28 at bDMARDs initiation3,68 ± 1,1Respiratory symptom at bDMARDs initation, n(%)12/40 (30)Lung involvement at the diagnosis, n (%)8/25 (24,2)Concomitant steroid, n (%)37/40 (92.5)Concomitant MTX, n (%)16/40 (40)Concomitant other csDMARDs, n (%)31/40 (%77,5)Initiated bDMARDs, TNFi/nonTNFi, n22/18RA-lung involvement type based on HRCT findings, n (%)-Rheumatoid nodulosis17 (42.5)-ILD-ground-glass opacity12 (30)-ILD-honeycombing11 (27.5)

Conclusion:

This study showed that the impact of TNFi and non-TNFi biologic treatments on the course of RA-assosiated lung involvement is similar. It also suggested that lung involvement at the diagnosis of RA was a significiant risk factor for the progress of the pulmonary disease.

References:

[1]Turesson C, O’Fallon WM, Crowson CS, Gabriel SE, Matteson EL. Extraarticular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann Rheum Dis. 2003;62(8):722–7

Disclosure of Interests:

None declared

SAT0344 LIMITED JOINT MOBILITY OF HAND IN SYSTEMIC SCLEROSIS PATIENTS BY USING “PRAYER” AND “TABLE TOP” SIGNS

Background:

Limited joint mobility (LJM) is a musculoskeletal disorder caused by flexion contractures of hand is a common complication in systemic sclerosis (SSc) patients. The distal parts of the upper limb (hands and fingers) is the most involved site in SSc.

Objectives:

In this study, we aimed to evaluate LJM in SSc patients and to determine the relationship between the clinical features of the disease.

Methods:

A total of 113 patients (>18 years old) diagnosed with diffuse cutaneous systemic sclerosis (DcSSc) and limited cutaneous systemic sclerosis (LcSSc) and 104 healthy controls were included in this study. LJM was evaluated with “prayer sign” and “table top sign” tests. LJM staging was done by Rosenbloom classification method(1, 2). LJM (+) and LJM (-) patients were compared in terms of demographic findings (gender, age and duration of disease), laboratory results (ESR, CRP, ANA, anti-topoisomerase I and anti-centromere) and modified Rodnan Skin Score (mRSS) results.

Results:

In our study, a total of 113 patients diagnosed with SSc and 104 healthy controls with similar age and gender distribution were included. While LJM (+) was detected in 75 (66.4%) (LcSSc = 38, DcSSc = 37) of the patients diagnosed with SSc, LJM (mild) (+) was detected in 3 (2.8%) of the control group. One of these people had right 2nd DIF joint contracture due to osteoarthritis, and 1 patient was found to have simple contractures due to minor hand injury previously (Table 1). A statistically significant difference was observed in between LcSSc and DcSSc patients according to the presence of LJM (p<0.001) (Table 2). There was a moderate positivity relationship between LJM and mRSS (LcSSc: r=0.449 ve p<0.001, DcSSc: r= 0.565 ve p<0.001) (Figure 1).

Table 1.

Comparison of demographic findings between SSc and Control group

SSc Group (n=113)Control Group (n=104)p valueAge, year57.02 ± 11.5858.47 ± 11.260.061Gender (F / M)98 (86.7) / 15 (13.3)65 (62.5) / 39 (37.5)0.064CRP (mg/L)5.45 ± 5.392.14 ± 1.12<0.001ESR (mm/hr)25.19 ± 18.914.46 ± 10.090.024Smoking, n (%)Smoker89 (78.8)70 (67.3)0.464Non-Smoker24 (21.2)34 (32.7)LJM (Absent / Present)Present75 (66.4)3 (2.8)<0.001Absent38 (33.6)101 (97.2)Rosenbloom classificationLcSSc (n=71) (%)DcSSc (n=42) (%)Total (n=113) (%)Normal46.511.933.6Mild22.514.319.5Moderate23.933.327.4Severe7.140.519.5Table 2.

Comparison of demographic and clinical findings LJM(-) and LJM(+) in SSc

LJM (-) (n=38)LJM (+) (n=75)p valueAge, year54.16 ± 11.8258.47 ± 11.260.061SSc Typen (%)n (%)LcSSc, n (%)DcSSc, n (%)33 (56.8)38 (50.7)<0.0015 (13.2)37 (49.3)Gender,F/M (%)37 (97.3) / 1 (2.7)61 (81.3) / 14 (18.7)0.018Raynaud’s (symptom duration), month148 (44-456)150 (35-588)0.990Non-raynaud (symptom duration), month108 (28-458)138 (38-447)0.132mRSS, median2 (0-14)8 (0-36)<0.001CRP (mg/L)4.21 ± 4.486.08 ± 5.710.069ESR (mm/hr)19.74 ± 1027.95 ± 21.60.270Renal crisis, n (%)1 (2.6)4 (5.3)0.662PAH, n (%)8 (21.1)14 (18.7)0.762ANA positivity, n (%)36 (94.7)70 (93.3)1Anti-centromere positivity, n (%)18 (47.4)19 (25.3)0.01Anti-topoisomerase-1, n (%)8 (21)34(45.3)0.01Smoking, n (%)n (%)n (%)Non-smoker30(78.9)59 (78.7)0.970Smoker8 (21.1)16 (21.3)Figure 1.

Conclusion:

In our study, it was found that LJM staging positively correlated with mRSS and DcSSc patients had more severe LJM findings than LcSSc. We conclude that “prayer sign” and “table top sign” tests used in hand evaluation in SSc patients have similar clinical results with mRSS and can be easily performed in daily practice in about 3 minutes.

References:

[1]Rosenbloom AL. Limitation of finger joint mobility in diabetes mellitus. The Journal of diabetic complications 1989; 3: 77-87.

[2]Nashel J, Steen V. Scleroderma mimics. Current rheumatology reports 2012; 14: 39-46.

Disclosure of Interests:

None declared

THU0398 DRUG RETENTION RATES AND TREATMENT OUTCOMES IN 1860 AXIAL SPONDYLOARTHRITIS PATIENTS TREATED WITH SECUKINUMAB IN ROUTINE CLINICAL PRACTICE IN 13 EUROPEAN COUNTRIES IN THE EUROSPA RESEARCH COLLABORATION NETWORK

Background:

To determine the real-life 6- and 12-month secukinumab effectiveness in Europe overall, as well as stratified by prior biologic disease-modifying anti-rheumatic drug (bDMARD)/targeted synthetic (ts)DMARD use.

Objectives:

Real-life data from axSpA patients treated with secukinumab from 13 countries in the European Spondyloarthritis (EuroSpA) Research Collaboration Network were pooled. We calculated proportions of patients achieving Bath Ankylosing Spondylitis Disease Activity Score (BASDAI) <2/<4 and Ankylosing Spondylitis Disease Activity Score (ASDAS) <1.3/<2.1 at 6 and 12 months, including with LUNDEX adjustments (crude value adjusted for drug retention). Retention rates were compared between b/tsDMARD naïve, 1 prior and ≥2 prior b/tsDMARD users with Kaplan-Meier analyses with log rank test and disease states by Chi-square test.

Methods:

A total of 1860 axSpA patients were included (Table 1). Overall 6/12-month secukinumab retention rates were 82%/72% and higher in bionaïve patients (Table 2, Figure). Significant differences in retention rates in-between the registries were found. Inactive disease/low-disease-activity (LDA) were achieved more often in bionaïve patients (Table 2).

Table 1All patients (n=1860)b/tsDMARD naïve (n=414)1 prior b/tsDMARD (n=448)≥2 prior b/tsDMARDs (n=998)Age (years), mean (SD)47 (12)45 (12)47 (12)48 (12)Men, %57%68%58%49%Years since diagnosis, mean (SD)10 (9)8 (9)10 (9)11 (9)Current smokers, %25 %27%25%23%Patient’s global (0-100), median (IQR)70 (50-81)80 (60-90)64 (50-80)70 (50-82)Physician’s global (0-100), median (IQR)45 (25-63)64 (43-78)45 (22-60)40 (20-58)C reactive protein (mg/L), median (IQR)8 (3-25)15 (5-31)7 (3-25)6 (2-22)Erythrocyte sedimentation rate (mm/h), median (IQR)22 (9-44)30 (14-44)24 (8-45)18 (8-42)Pain (0-100), median (IQR)70 (50-81)80 (65-90)65 (49-80)70 (50-80)BASDAI, median (IQR)6.2 (4.6-7.6)6.8 (5.2-8.0)5.9 (4.2-7.2)6.1 (4.4-7.6)BASFI, median (IQR)5.5 (3.2-7.3)6.1 (3.2-7.6)4.8 (2.8-6.8)5.5 (3.3-7.2)ASDAS, median (IQR)3.6 (2.9-4.3)4.2 (3.5-4.8)3.5 (2.7-4.2)3.5 (2.8-4.2)Table 2MonthsAll patients (n=1860)b/tsDMARD naïve (n=414)1 prior b/tsDMARD (n=448)≥2 prior b/tsDMARDs (n=998)p-value*Secukinumab retention rate, % (95%CI)682% (80-84%)90% (87-93%)83% (79-86%)78% (76-81%)0.0011272% (69-74%)84% (81-88%)73% (69-78%)66% (63-69%)<0.001BASDAI <2, % Crude626373518<0.001 LUNDEX adjusted21342813<0.001 Crude1225412918<0.001 LUNDEX adjusted16311811<0.001BASDAI <4, % Crude651716040<0.001 LUNDEX adjusted40654730<0.001 Crude1251765639<0.001 LUNDEX adjusted32573623<0.001ASDAS <1.3, % Crude69131360.001 LUNDEX adjusted712115<0.001 Crude1211181570.002 LUNDEX adjusted713940.002ASDAS <2.1, % Crude6243226200.002 LUNDEX adjusted19292115<0.001 Crude1227442721<0.001 LUNDEX adjusted17331712<0.001

*Comparisons between b/tsDMARD naïve, 1 prior and ≥2 prior b/tsDMARD users were performed with Kaplan-Meier with log-rank test or Chi-Square test, as appropriate

Conclusion:

In this real-life study of 1860 patients with axSpA in 13 European countries secukinumab retention was high and significantly higher for bionaïve patients. Overall, a higher proportion of bionaïve than previous b/tsDMARD users achieved inactive disease/LDA.

Figure

Acknowledgments:

Novartis and IQVIA for supporting the EuroSpA RCN

Disclosure of Interests:

Brigitte Michelsen Grant/research support from: Research support from Novartis, Consultant of: Consulting fees Novartis, Ulf Lindström: None declared, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Adrian Ciurea Consultant of: Consulting and/or speaking fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis and Pfizer., Jakub Zavada Speakers bureau: Abbvie, UCB, Sanofi, Elli-Lilly, Novartis, Zentiva, Accord, Anne Gitte Loft Grant/research support from: Novartis, Consultant of: AbbVie, MSD, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer and UCB, Manuel Pombo-Suarez Consultant of: Janssen, Lilly, MSD and Sanofi., Speakers bureau: Janssen, Lilly, MSD and Sanofi., Fatos Onen: None declared, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Maria Jose Santos Speakers bureau: Novartis and Pfizer, 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, Anna-Mari Hokkanen: None declared, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Karel Pavelka Consultant of: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Speakers bureau: Abbvie, MSD, BMS, Egis, Roche, UCB, Medac, Pfizer, Biogen, Carlos Sánchez-Piedra: None declared, Servet Akar: None declared, Joe Sexton: None declared, Matija Tomsic: None declared, Helena Santos Speakers bureau: AbbVie, Eli-Lilly, Janssen, Pfizer, Novartis, Marco Sebastiani: None declared, Jenny Osterlund: None declared, Arni Jon Geirsson: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene and GSK., Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Stylianos Georgiadis Grant/research support from: Novartis, Cecilie Heegaard Brahe Grant/research support from: Novartis, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, 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

SAT0544 USE OF BIOLOGICAL DMARDS IN PATIENTS WITH ADULT-ONSET STILL’S DISEASE: RESULTS FROM TURKBIO REGISTRY

Background:

Adult-onset Still’s disease (AOSD) is a rare multisystemic inflammatory disorder, and is diagnosed by exclusion. AOSD is generally treated with nonsteroidal antiinflammatory drugs, corticosteroids, and conventional disease modifiying antirheumatic drugs (cDMARDs). Biological disease modifiying antirheumatic drug (bDMARD) therapy are recommended in AOSD patients who are refractory to tradional therapy, and bDMARDs is becoming increasingly important in AOSD treatment.

Objectives:

To evaluate the use of bDMARDs and drug survival in AOSD patients.

Methods:

TURKBIO registry is the Turkish version of Danish DANBIO rheumatological database which has been established in 2011. All patients with AOSD who received biological agents registered in TURKBIO registry between dates of October 2011 and October 2019 were included in this study. The demographic data, response of therapy, frequency of using and switching biological agents were collected.

Results:

As of October, 21 AOSD patients were recruited. Mean age of patients was 34.6±7.3 (min-max: 24-49) years, mean disease duration was 9.3±7.4 (min-max: 1-22) years, and 57.1% of patients was female. Mean duration from onset to start of bDMARDs was 7±6.1 (min-max: 0.5-21) years. It was observed that 13 patients (61.9%) received tocilizumab (TCZ), 6 patients (28.6%) received IL-1 inhibitors (5 anakinra and one canakinumab), 2 patients (9.5%) received certolizumab and one patient (4.8%) received etanercept as a first-line bDMARDs. The most frequently used biological agents in current treatment were as follows: 52.4% of patients received TCZ and 33.3% received IL-1 inhibitors (4 anakinra, 3 canakinumab), and the most frequently used concomitant drugs were methotrexate (47.6%) and hydroxychloroquine (14.3%). The switching rate was 33.3%, and in half of them the reason of switching was adverse events. The median drug survival for bDMARDs was 28.6 months (Table).

Table.

Demographic, laboratory features and management of AOSD

(median;25-75)n=21Age (year)34.7 (28.3-40.6)Gender (Female) n(%)12 (57.1)Disease duration (year)8 (2-17)Duration from onset to start of bDMARs (year)6 (1.5-10)ESR (on onset)44 (21-66)CRP (on onset)65 (3.1-108)Current bDMARDs n(%) Tocilizumab11(52.4) IL-1 inhibitors7 (33.3) Etanercept1 (4.8) Certolizumab2 (9.5)Concomitant cDMARD n(%) Methotrexate10 (47.6) Leflunomide4 (19) Sulfasalazine1 (4.8) Hydroxychloroquine3 (14.3)bDMARDs Survival (months)28.6 (5.5-75)Switching Rate n(%)7 (33.3)Adverse Event n(%)3 (14.3)

Conclusion:

This is the first evaluation of AOSD patients who used biological agents from TURKBIO registry. According our data, TCZ and anti-IL1 agents were the most frequent biological choices. The limitation of this study was the low number of the patients with AOSD who used biological agents.

References:

[1].Zhou S, Qiao J, Bai J, Wu Y, Fang H. Biological therapy of traditional therapy-resistant adult-onset Still’s disease: an evidence-based review. Ther Clin Risk Manag 2018;14:167-71.

Acknowledgments:

None

Disclosure of Interests:

None declared

FRI0276 EARLY TREATMENT WITH ANTI-TNF IS ASSOCIATED WITH HIGHER RESPONSE RATES IN PATIENTS WITH ACTIVE AXSPA

Background:

Treatment options for axial spondyloarthritis (axSpA) is currently limited, and up to 40% of the patients require biologic therapies to control symptoms. Early commencement of biologics suggested to have higher response rates but data regarding this subject is limited.

Objectives:

The primary aim was to investigate tumor necrosis factor inhibitor (TNFi) response and retention rates in axSpA patients who were treated in the early disease period (symptom duration (≤5 years). Our secondary aim was to identify factors predicting response to TNFi.

Methods:

Adult axial SpA patients who started TNFi treatments within the five years of their symptoms were identified and defined as “Group 1”. Patients whose TNFi treatments started five years after their initial symptoms served as a control group (Group 2: 5-10 years and Group3: ≥10 years). Response and survival rates at 6, 12, and 24 months were calculated. Predictors of response on TNFi survival at 24 months were also analyzed.

Results:

There was a total of 364 axiSpA (Group 1: 95, Group 2: 82 and Group 3: 187) patients in the study (69.8% male, 46.8±12.6 years). Group 1 patients tended to be younger, with a lower baseline CRP titers and lower HLA–B27 rate compared to the other groups. Drug survival rates were similar between the groups. This finding also remained similar when AS and nraxSpA patients analyzed separately. However, regardless of symptom duration, the drug retention rates were significantly higher in the AS group than in nraxSpA (Table 2). ASAS40 responses were higher in Group 1 than in Group 3 both at 12 and 24 months. Predictors of response based on ASAS40 at 24 months were treatment within the five years of the symptoms (OR:2.2) and age at baseline (OR:0.97) in univariate analysis. However, baseline ASDAS (OR:1.4) was the only factor in multiple regression.

Conclusion:

In this study we showed the following: 1) TNFi started in the early disease course resulted in a better ASAS40 response at both 12 and 24 months, 2) TNFi timing (started in the early or late disease period) seems not affecting drug retention rates, and 3) baseline disease activity is the most important predictor in achieving ASAS40 response at 24 months.

Disclosure of Interests:

None declared

AB0202 GENETIC SUSCEPTIBILITY AND PHENOTYPE OF RHEUMATOID ARTHRITIS IN DANISH AND TURKISH PATIENTS

Background:

Previous studies indicate that genetic susceptibility and phenotype of rheumatoid arthritis (RA) differ between the populations.

Objectives:

To compare the clinical, serologic expression and the presence of shared epitopes (SE) of incident RA in two different populations, one from Northern and the other from Southern Europe.

Methods:

Data on incident RA patients fulfilling EULAR/ACR 2010 classifications criteria for RA were collected at Rheumatology Departments in Denmark and Turkey in 2015-2016. Patients were assessed using the same standardized protocol in both populations. SE carrier status were assigned, according to the du Montcel classification based, into six allele groups:S1, S2,S3D,S3PandX, where S2 and S3P are RA risk-enhancing alleles and S1 and S3D are RA protective alleles of the shared epitope(1).

Results:

109 incident RA patients from Denmark and 114 incident RA patients from Turkey were enrolled. Genetic data were available from 87% of the patients.

Table 1.

Characteristics of incident rheumatoid arthritis patients in Denmark and Turkey

Danish patientsn=109Turkish patientsn=114P-valueAge at diagnosis, years60 (49-69)52 (43-64)0.003Female, %64740.12Symptom duration, months7 (4-21)6 (2-22)0.6Smoking status Never smoker, %43440.98 Former smoker, %28310.68 Current smoker, %29250.54VAS pain (0-100 mm)45 (28-66)60 (41-72)0.01VAS fatigue (0-100 mm)51 (29-69)50 (20-70)0.32VAS global, patient (0-100 mm)60 (31-80)60 (41-73)0.77Swollen joint count (0-28)7 (4-11)3 (1-6)<0.00001Tender joint count (0-28)7 (3-11)5 (2-8)0.04HAQ score (0-3)0.75 (0.34-1.25)1.0 (0.25-1.75)0.02DAS284.7 (4.1-5.5)4.3 (3.3-5.2)0.01CRP, mg/l7 (3.0-18.5)8 (3.1-22.6)0.54IgM RF positive, %70660.58ACPA positive, %63750.1

Medians (interquartile range) for continuous variables

VAS – Visual Analog Scale, HAQ - Health Assessment Questionnaire, DAS28 - Disease Activity Score 28 joints, CRP – C-reactive protein, RF – Rheumatoid Factor, ACPA - Anti-Citrullinated Protein Antibodies.

Table 2.

Shared epitope allele carrier frequencies.

AlleleDanish patientsn=98Turkish patientsn=95P-valueS1, % (n)19 (37)22 (42)0,43S2, % (n)26 (51)8 (16)<0,00001S3D, % (n)6 (12)21 (39)0,000029S3P, % (n)27 (52)29 (56)0,52X, % (n)22 (44)19 (37)0,47

We found no associations between the risk-enhancing alleles and the presence of IgM rheumatoid factor or ACPA.

Conclusion:

The Turkish patients were younger and had lower disease activity than Danish at the time of diagnosis. Our study found an enhanced genetic susceptibility to RA in Danish compared to Turkish patients with a higher prevalence of risk-enhancing RA alleles and a lower prevalence of protective alleles.

References:

[1]Tezenas du Montcel S, Michou L, Petit-Teixeira E, Osorio J, Lemaire I, Lasbleiz S, et al. New classification of HLA–DRB1 alleles supports the shared epitope hypothesis of rheumatoid arthritis susceptibility.Arthritis Rheum2005; 52: 1063–8.

Disclosure of Interests:

None declared

AB1071 COEXISTENCE OF FAMILIAL MEDITERRANEAN FEVER WITH SPONDYLOARTHRITIS: CLINICAL CHARACTERISTIC AND TREATMENT OUTCOMES

Background:

Studies indicate that there is an association with spondyloarthritis (SpA) and familial mediterranean fever (FMF) based on the following: 1) increased incidence of sacroiliitis in FMF, 2) MEFV gene mutations are significantly increased in ankylosing spondylitis (AS) and 3) both SpA and FMF show some common clinical manifestations such as the pattern of arthritis. However, characteristics of SpA associated with FMF such as clinical characteristics and treatment outcomes have been poorly documented and additional data is required on this topic.

Objectives:

To study the clinical and treatment characteristics of patients associated with FMF and SpA.

Methods:

Twenty-eight patients with FMF and SpA who were registered in our database were included in the study. Demographic, clinical, and laboratory data were collected. HLA-B27, MEFV gene mutations were recorded. Pelvic radiographs and sacroiliac joint magnetic resonance imaging (MRI) (if present) were scored based on the modified New York criteria (mNYc) and ASAS MRI definitions respectively. Treatment data were also recorded.

Results:

There were 28 FMF-SpA patients in the study (mean age 45.1±16.4 years, 57.2% male). The mean age of onset of FMF and SpA were 31.9±17.9 and 35.5±16.2 years respectively. SpA patients were predominantly axial (n=21, 75%), and only 7 (25%) were mainly peripheral type. Fifteen (53.5%) patients were satisfying mNYc for AS. Four (14%) patients were fulfilling ASAS non radiographic axial SpA definition. Bone marrow edema was detected in (36%) of the patients who underwent MRI (n=14). Two (7.1%) patients had SpA symptoms but did not classify into any of the ASAS arms. Arthritis observed in 19 (67.8%) patients with mostly in oligoarthritis type (79%). Ankle and knees were the most affected joints. Total hip replacement was present in 7% of the patients. Amyloidosis confirmed by biopsy was detected in 4 (14%) patients. Enthesitis (11%), uveitis (11%), Chron’s disease (7%), dactylitis (3%), and psoriasis (3%) was also noted. Nearly %30 patients required non IL-1 biologic therapy (BTx) to control SpA symptoms (axial 70%, peripheral 30%). 40% of the patients needed to switch non IL-1 BTx to another biologic agent because of lack of efficacy on SpA symptoms (25%) or due to the adverse event (25%) and active FMF not responding to non IL-1 biological agent (50%).

Conclusion:

We showed the following: 1) more female predominance in FMF-SpA patients compared to classic SpA, 2) FMF-SpA patients had lower frequency of HLA B27, 3) up to %30 of the patients required non-IL-1 BTx to control SpA symptoms and 4) in patients on non IL-1 BTx FMF symptoms responded in 80%.

Table 1.

The clinical characteristics of FMF-SPA patients

Age*45.1±16.4Male, n (%)16 (57.2)SpA symptom duration,years*9.5±7.0FMF symptom duration,years*12.6±9.6HLA-B27 positivity, n (%)5 (29.4)Mainly axial involvement, n (%)21 (75)Mainly peripheral involvement, n (%)7(25)mNY positivity, n (%)15 (53.5)MEFV (M694V) mutation18MEFV (non M694V) mutation19Amyloidosis, n (%)4 (14.2)Non IL-1 biological treatment for SpA symptoms, n (%)10 (35.7)

*(mean ±S.D)

Disclosure of Interests:

None declared

SAT0423 LONG-TERM SURVIVAL OF THE FIRST BIOLOGIC TREATMENT IN PSORIATIC ARTHRITIS AND THE EFFECT OF THE SELECTED TREATMENT ON DRUG SURVIVAL; TURKBIO REGISTRY

Background:

Currently, biologic treatments are used effectively in patients with psoriatic arthritis (PsA).

Objectives:

The aim of this study was to evaluate and compare long-term drug survival of the first biologic treatments including adalimumab, certolizumab, etanercept, golimumab, infliximab, secukinumab and ustekinumab in patients with PsA.

Methods:

PsA patients, electronically registered at each visit in the TURKBIO database between 2011 and 2019 were included in the study. PASW 18.0 for Windows was used for statistical analysis. Drug survival rates were calculated by Kaplan Meier method.

Results:

355 patients (227 women; axial PsA = 48, peripheral PsA = 307) were included in the study (Table 1). Adalimumab was the most commonly used first biologic treatment (n=125; 37.6%). The rate of drug survival was found to be 0.75 at month 60 in patients receiving the first biologic treatment (Figure 1). There was no significant difference in drug survival rate between tumor necrosis factor alpha inhibitor (TNFi) and non-TNFi biologic drugs (p=0.56). No difference was also found in drug survival rates between each biologic treatment.

Table 1.

Initial demographic and clinical datas of patients with PsA

PsA Patients (n=355)Females, n (%)227 (63,9)Age of diagnosis, years*34,6 (27-42)CRP baseline*6 mg/ L (3-15)ESR baseline*24 mm/h (10-38)Smoking, n (%)Current99 (28,5)Never192 (55,3)Previous56 (16,2)HLA B27 positivity,n (%)41 (26,4)First biologic agent, n (%)-TNFi332 (95,4)AdalimumabEtanercept125 (37,6)80 (24,1)Golimumab52 (15,6)Certolizumab44 (13,3)Infliximab31 (9,4)- Other biologic agents16 (4,6)Secukinumab13 (81,3)Ustekinumab3 (18,7)

*median (min-max)

Conclusion:

The results of this study establish that more than half of patients with PsA can remain in their initial biologic treatment over a long term. It has been observed that the choice of biologic treatment did not effect the drug survival in PsA.

Disclosure of Interests:

None declared

Sleep Disturbances in MCI and AD: Neuroinflammation as a Possible Mediating Pathway

Mild cognitive impairment (MCI) and Alzheimer’s disease (AD) affect a high proportion of the elderly population with an increasing prevalence. Sleep disturbances are frequent in those with MCI and AD. This review summarizes existing research on sleep disturbances and neuroinflammation in MCI and AD. Although strong evidence supports various pathways linking sleep and AD pathology, the temporal direction of this central relationship is not yet known. Improved understanding of sleep disturbance and neuroinflammation in MCI and AD may aid in the identification of targets for their prevention.

CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea

BACKGROUND/OBJECTIVES

Obstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial.

DESIGN

Quasi-experimental pilot clinical trial with CPAP adherence defined as CPAP use 4 hours or more per night over 1 year.

SETTING

Sleep and geriatric clinics and community.

PARTICIPANTS

Older adults, aged 55 to 89 years, with an apnea-hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI -CPAP), n = 25.

INTERVENTION

CPAP.

MEASUREMENTS

The primary cognitive outcome was memory (Hopkins Verbal Learning Test-Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, and Clinical Dementia Rating.

RESULTS

Statistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI -CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73-2.62), with a 6-month effect size (ES) of 0.46 and a 1-year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI -CPAP group.

CONCLUSION

Controlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition, compared with a nonadherent control group, and may slow the trajectory of cognitive decline.

TRIAL REGISTRATION NUMBER

Memories; NCT01482351; https://clinicaltrials.gov/ct2/show/NCT01482351?cond=MCI+and+OSA&rank=1 J Am Geriatr Soc 67:558-564, 2019.

Observation and Interview-based Diurnal Sleepiness Inventory for measurement of sleepiness in older adults

INTRODUCTION

There is no established reference standard for subjective measures of sleepiness in older adults.

METHODS

This study compares the Observation and Interview-based Diurnal Sleepiness Inventory (ODSI) with two existing instruments for measurement of sleepiness and daily functioning, the Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ).

RESULTS

A total of 125 study participants were included in this study and were administered the ODSI, ESS and FOSQ; subjects had a mean age of 70.9 ± 5.27 years, mean Apnea-Hypopnea Index of 31.9 ± 27.9 events/hour and normal cognitive functioning (Mini-Mental State Examination score > 24). The ODSI showed a significant association with the ESS (Spearman's ρ: 0.67, P < 0.001) and with the FOSQ (Spearman's ρ: -0.52, P < 0.001). The ODSI 1 item (assessing sleepiness in active situations) was borderline significantly correlated with the ESS (β = 0.14; 95% confidence interval [CI], -0.01 to 0.29; P = 0.069). ODSI 2 item (sleepiness in passive situations) was correlated with the ESS (β = 1.65; 95% CI, 1.32 to 1.98; P < 0.001). Both ODSI 1 (β = -0.15; 95% CI, -0.24 to -0.07; P < 0.001) and ODSI 2 (β = -0.35; 95% CI, -0.55 to 0.16; P < 0.001) were significantly correlated with the FOSQ.

CONCLUSION

The ODSI is a suitable measure of sleepiness and is appropriate for usage in clinical care in older adults.

Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force

Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.

Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.

Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulatedviadiscussion and consensus.

In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.

A Three-Item Instrument for Measuring Daytime Sleepiness: The Observation and Interview Based Diurnal Sleepiness Inventory (ODSI)

STUDY OBJECTIVES

We aimed to develop a new three-item assessment tool for daytime sleepiness in older adults, the Observation and interview-based Diurnal Sleepiness Inventory (ODSI) and determine its validity, internal consistency, test-retest reliability, and optimal cutoff score.

METHODS

A total of 133 elderly subjects including 73 patients with obstructive sleep apnea (OSA) (mean age, 79 y) and 60 controls (mean age, 80 y) were consecutively enrolled and answered all questionnaires. The ODSI questionnaire was validated using the Epworth Sleepiness Scale considered as a gold standard. Reliability, validity, and cut-points were tested.

RESULTS

The ODSI has acceptable validity, internal consistency, and test-retest reliability properties. The ODSI has internal consistency and a reliability coefficient (Pearson rho) of 0.70 for its three items, which suggests strong reliability. The estimated sensitivity and specificity were 0.842 with 95% confidence interval [0.624; 0.945] and 0.851 [0.761; 0.911], respectively. The consistency of summated scale scores during test and retest sessions was high (r = 0.970, 95% bootstrap confidence interval [0.898; 0.991]). Receiver operating characteristic analysis suggests that a cut-point of 6 is effective for identifying older adults with excessive levels of daytime sleepiness.

CONCLUSIONS

The ODSI is a brief, valid, easy-to-administer three-item assessment that can screen for excessive daytime sleepiness among elderly patients with OSA.